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WAL-MART PHARMACY 10-0167
CH06273H MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
Hamburg High School School Based Clinic
Type
HRSA-Funded Health Center
340B ID
CH06273H
Entity Address
1119 S Main St
Hamburg, AR 71646-8983
Grant Number
H80CS00638
Participating Start Date
7/1/2016
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0167
Pharmacy Address
910 UNITY RD
CROSSETT, AR 71635
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
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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