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EAST END PHARMACY
CH06273AC Mainline Health Systems Inc
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Covered Entity Details
Entity Name
Mainline Health Systems Inc
Subdivision Name
Warren Eastside School
Type
HRSA-Funded Health Center
340B ID
CH06273AC
Entity Address
408 N Bradley St
Warren, AR 71671-2208
Grant Number
H80CS00638
Participating Start Date
10/1/2022
Last Recertification Date
2/6/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
EAST END PHARMACY
Pharmacy Address
20381 ARCH ST
LITTLE ROCK, AR 72206-9218
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
East End Pharmacy
Shane Greene, Pharmacy contact
(501) 888-2830
Signed By Date
10/16/2023
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