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SHERIDAN FAMILY PHARMACY LLC
CH06273Z Mainline Health Systems Inc
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Covered Entity Details
Entity Name
Mainline Health Systems Inc
Subdivision Name
Sheridan High School Clinic
Type
HRSA-Funded Health Center
340B ID
CH06273Z
Entity Address
512 W Church St STE A
Sheridan, AR 72150-2016
Grant Number
H80CS00638
Participating Start Date
7/1/2022
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
SHERIDAN FAMILY PHARMACY LLC
Pharmacy Address
677 HERITAGE DRIVE
SHERIDAN, AR 72150
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
Mccoy-Tygart Drug
Casey Hedden, Pharmacist in Charge
(870) 942-5121
Signed By Date
10/16/2023
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