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DELTA DRUG OF DERMOTT INC
CH06273C MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
Dermott Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH06273C
Entity Address
300 S School St
Dermott, AR 71638-2127
Grant Number
H80CS00638
Participating Start Date
10/1/1995
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
DELTA DRUG OF DERMOTT INC
Pharmacy Address
111 E PEDDICORD ST
DERMOTT, AR 71638
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
City Drug of Monticello
Lynn Crouse, Owner
(870) 224-0650
Signed By Date
10/16/2023
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