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CH06273AC Mainline Health Systems Inc (Terminated)
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Main Details
Name
Mainline Health Systems Inc
Subdivision Name
Warren Eastside School
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035245
340B ID
CH06273AC
Grant Number
H80CS00638
Additional Details
Current Program Status
Terminated
Registration Date
8/23/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/29/2022
Last Recertification Date
2/6/2023
Termination Date
Termination Reason
1/1/2024
Site closure
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
408 N Bradley St
Warren, AR 71671-2208
Billing Address
Mainline Health Systems, Inc.
PO Box 509
Dermott, AR 71638
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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