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WALGREEN CO
CH062730 MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
MAINLINE HEALTH SYSTEM, INC.
Type
HRSA-Funded Health Center
340B ID
CH062730
Entity Address
233 NORTH MAIN STREET
PORTLAND, AR 71663-0100
Grant Number
H80CS00638
Participating Start Date
12/1/1992
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10666
640 W GAINES STREET
MONTICELLO, AR 71655-4675
Pharmacy Comments
Contract Details
Approval Date
5/10/2012
Contract Begin Date
5/10/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/17/2012
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