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DELTA DRUG OF DERMOTT INC
CH06273D MAINLINE HEALTH SYSTEMS INC
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Covered Entity Details
Entity Name
MAINLINE HEALTH SYSTEMS INC
Subdivision Name
Monticello Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH06273D
Entity Address
535 Jordan Dr.
Monticello, AR 71655-5714
Grant Number
H80CS00638
Participating Start Date
10/1/2012
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
DELTA DRUG OF DERMOTT INC
Pharmacy Address
111 E PEDDICORD ST
DERMOTT, AR 71638
Pharmacy Comments
Contract Details
Approval Date
1/14/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
GARY ALLAN NICHOLS, Executive Director
(870) 538-5414
Contract Pharmacy Representative
Pharmacy
JEFF F. DUNN, OWNER/PHARMACIST
(870) 538-5510
Signed By Date
1/14/2018
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