Contract Pharmacy Details

WALGREEN CO.
CHC26592-02 COASTAL COMMUNITY HEALTH SERVICES, INC.

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 # 07848
4575 ALTAMA AVE
BRUNSWICK, GA 31520

Pharmacy Comments

Contract Details

Approval Date

7/3/2017

Contract Begin Date

10/1/2017

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

Barbara Meyers, CEO
(912) 574-5074

Contract Pharmacy Representative

Walgreens
Sharon Huiett, Analyst, 340B Client Relationship
(847) 964-8687

Signed By Date

7/3/2017

340B Drug Pricing Program Database