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SULLIVAN PHARMACY
CH06373P 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 - Nemo Vista School Based Health Center
Type
HRSA-Funded Health Center
340B ID
CH06373P
Entity Address
1094 Catholic Point Road
Center Ridge, AR 72027-8403
Grant Number
H80CS00641
Participating Start Date
1/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SULLIVAN PHARMACY
Pharmacy Address
BUNDY FAMILY PHARMACY, LLC
731 N MAIN ST STE B
HARRISON, AR 72601
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Becky Blair, CFO
(870) 448-5733 Ext: 2008
Contract Pharmacy Representative
Sullivan Pharmacy
Addie Bundy, Owner
(870) 741-2119
Signed By Date
10/11/2023
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