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CH06273AE Mainline Health Systems Inc (Active)
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Main Details
Name
Mainline Health Systems Inc
Subdivision Name
East End Intermediate School Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035539
340B ID
CH06273AE
Grant Number
H80CS00638
Additional Details
Current Program Status
Active
Registration Date
10/4/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/13/2022
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
5205 West Sawmill Road
Little Rock, AR 72206
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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