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WALGREEN CO.
CHC26592-02 COASTAL COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
McIntosh Center
Type
HRSA-Funded Health Center
340B ID
CHC26592-02
Entity Address
6574 Shellman Bluff Road, NE
Townsend, GA 31331
Grant Number
H80CS26592
Participating Start Date
7/1/2017
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA; WALGREENS #10506
2270 US HIGHWAY 17
RICHMOND HILL, GA 31324
Pharmacy Comments
Contract Details
Approval Date
5/24/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Walgreens
Jim Guth, Regional Manager, 340B Client Relationship
(847) 964-4749
Signed By Date
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