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EUDORA DRUG STORE
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
EUDORA DRUG STORE
Pharmacy Address
200 S. MAIN ST
EUDORA, AR 71640
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/2/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
Eudora Drug
Khalil Lynn Crouse, Owner
(870) 364-5155
Signed By Date
7/13/2015
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