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FRED'S PHARMACY #1908
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
FRED'S PHARMACY #1908
Pharmacy Address
700 N MAIN ST
HAMBURG, AR 71646-2718
Pharmacy Comments
Contract Details
Approval Date
4/9/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
Shannon Strickland, SVP, Pharmacy Development
(901) 238-3113
Signed By Date
4/9/2015
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