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WAL-MART PHARMACY 10-0289
CH06273K MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
Dermott School Clinic
Type
HRSA-Funded Health Center
340B ID
CH06273K
Entity Address
525 E Speedway St
Dermott, AR 71638-2322
Grant Number
H80CS00638
Participating Start Date
4/1/2017
Last Recertification Date
2/12/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0289
Pharmacy Address
1001 HIGHWAY 65 S
MC GEHEE, AR 71654
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
4/1/2025
Covered Entity Terminated
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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