Contract Pharmacy Details

GREEN FOREST PHARMACY
CH06373F BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Covered Entity Details

Entity Name

BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Subdivision Name

Boston Mountain Rural Health Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH06373F

Entity Address

1103 West Main Street
Green Forest, AR 72638-0000

Grant Number

H80CS00641

Participating Start Date

1/1/2010

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

GREEN FOREST PHARMACY

Pharmacy Address

309 EAST MAIN ST
GREEN FOREST, AR 72638

Pharmacy Comments

Contract Details

Approval Date

1/28/2010

Contract Begin Date

1/28/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

MELANIE CAMPBELL, EXECUTIVE DIRECTOR
(870) 448-3976

Contract Pharmacy Representative

DUSTY BARRETT, PRESIDENT
(870) 438-5614

Signed By Date

1/5/2010

340B Drug Pricing Program Database