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POLK PHARMACY MANAGEMENT
CH062090 MID-DELTA HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MID-DELTA HEALTH SYSTEMS INC
Subdivision Name
Mid Delta Health Center
Type
HRSA-Funded Health Center
340B ID
CH062090
Entity Address
245 Madison St
Clarendon, AR 72029-2706
Grant Number
H80CS17147
Participating Start Date
10/1/2006
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
POLK PHARMACY MANAGEMENT
Pharmacy Address
333 MADISON ST
CLARENDON, AR 72029-2717
Pharmacy Comments
Contract Details
Approval Date
9/19/2019
Contract Begin Date
9/19/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVIN J. SLIGER, EXECUTIVE DIRECTOR
(870) 747-3381 Ext: 3060
Contract Pharmacy Representative
Polk Pharmacy
Marco Middleton, Pharmacist
(870) 747-5664
Signed By Date
9/19/2019
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