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BRINKLEY FAMILY PHARMACY
CH06209B Mid-Delta Health Systems Inc
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Covered Entity Details
Entity Name
Mid-Delta Health Systems Inc
Subdivision Name
Mid-Delta Health Systems - Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CH06209B
Entity Address
245 Madison St
Clarendon, AR 72029-2706
Grant Number
H80CS17147
Participating Start Date
4/1/2022
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
BRINKLEY FAMILY PHARMACY
Pharmacy Address
1415 PINECREST ST.
SUITE 8
BRINKLEY, AR 72021
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MONICA L LINDLEY, CEO
(870) 672-1527 Ext: 8706721527
Contract Pharmacy Representative
Polk Pharmacy
Marco Middleton, Pharmacist
(870) 747-5664
Signed By Date
10/13/2023
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