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CH06273W Mainline Health Systems Inc (Active)
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Main Details
Name
Mainline Health Systems Inc
Subdivision Name
Mainline UAM
Type
HRSA-Funded Health Center
Site ID
BPS-H80-038864
340B ID
CH06273W
Grant Number
H80CS00638
Additional Details
Current Program Status
Active
Registration Date
11/2/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/3/2021
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
Mainline Health Systems
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Primary Contact
Mainline Health Systems
Courtney Keller, PharmD
(870) 538-5414
Addresses
Street Address
136 University Ct
Monticello, AR 71655
Billing Address
Mainline Health Systems, Inc.
342 Hwy 425 S
Monticello, AR 71655
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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