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DOCTOR'S ORDERS PHARMACY #2
CH06273X Mainline Health Systems Inc
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Covered Entity Details
Entity Name
Mainline Health Systems Inc
Subdivision Name
Star City Dental
Type
HRSA-Funded Health Center
340B ID
CH06273X
Entity Address
557 Kirkwood Rd
Star City, AR 71667-8843
Grant Number
H80CS00638
Participating Start Date
1/1/2022
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
DOCTOR'S ORDERS PHARMACY #2
Pharmacy Address
DOCTOR'S ORDERS PHARMACY #2
2302 W 28TH AVE STE B
PINE BLUFF, AR 71603
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
Whitehall Pharmacy LLC
Lelan Stice, Owner
(870) 671-4914
Signed By Date
10/16/2023
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