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SULLIVAN MAIN STREET PHARMACY
CH063730 BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
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Covered Entity Details
Entity Name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Subdivision Name
BOSTON MOUNTAIN RURAL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH063730
Entity Address
2263 HIGHWAY 65 NORTH
MARSHALL, AR 72650-1030
Grant Number
H80CS00641
Participating Start Date
4/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SULLIVAN MAIN STREET PHARMACY
Pharmacy Address
731 N. MAIN ST
SUITE B
HARRISON, AR 72601-2912
Pharmacy Comments
Contract Details
Approval Date
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2021
Ownership change
Contacts
Covered Entity Signing Official
Becky Blair, CFO
(870) 448-5733 Ext: 2008
Contract Pharmacy Representative
Sullivan Main Street Pharmacy
Mike Richardson, Owner
(870) 741-2119
Signed By Date
4/1/2019
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