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COASTAL FAMILY HEALTH CENTER, INC
CH04243L THE COASTAL FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
THE COASTAL FAMILY HEALTH CENTER INC
Subdivision Name
GULFPORT II HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04243L
Entity Address
1408 44th Ave
Gulfport, MS 39501-2554
Grant Number
H80CS00188
Participating Start Date
7/1/2015
Last Recertification Date
2/12/2016
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
COASTAL FAMILY HEALTH CENTER, INC
Pharmacy Address
1029B DIVISION ST
BILOXI, MS 39530
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Coastal Family Health Center
Larry J. Knight, COO
(228) 374-2494 Ext: 1116
Signed By Date
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