340B Drug Pricing Program Database

Pharmacy Name

SUPER 1 FOODS PHARMACY #622

Pharmacy Address

2800 S. HAZEL STREET
PINE BLUFF, AR 71603

Pharmacy Comments

Approval Date

7/12/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2022
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Sandra J. Brown, Chief Executive Officer
(870) 543-2300

Contract Pharmacy Representative

Brookshires
W Mark Sullivan, Pharmacy Operations
(903) 877-6852

Signed By Date

7/12/2019