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FOOTE'S SUPER DRUG NO 4, INC
CH06273A MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
WILMOT CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06273A
Entity Address
203 Mccombs St
Wilmot, AR 71676
Grant Number
H80CS00638
Participating Start Date
10/1/1995
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
FOOTE'S SUPER DRUG NO 4, INC
Pharmacy Address
109 EAST ADAMS STREET
PO BOX 8
HAMBURG, AR 71646
Pharmacy Comments
Contract Details
Approval Date
11/21/2009
Contract Begin Date
11/21/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
JEFF S. FOOTE, PRESIDENT
(870) 853-5275
Signed By Date
11/19/2009
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