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KELLEY DRUG AND SELECTIONS
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
KELLEY DRUG AND SELECTIONS
Pharmacy Address
104 HOLLY STREET
P O BOX 21
MCGEHEE, AR 71654
Pharmacy Comments
Contract Details
Approval Date
10/3/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2019
Ownership change
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
KELLEY DRUG AND SELECTIONS
James Kelley, Owner/Pharmacist
(870) 222-5071
Signed By Date
10/3/2013
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