Contract Pharmacy Details

CLINTON DRUG
CH063730 BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Covered Entity Details

Entity Name

BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Subdivision Name

BOSTON MOUNTAIN RURAL HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH063730

Entity Address

2263 HIGHWAY 65 NORTH
MARSHALL, AR 72650-1030

Grant Number

H80CS00641

Participating Start Date

4/1/2006

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

CLINTON DRUG

Pharmacy Address

2526 HWY 65 SOUTH, SUITE 101
CLINTON, AR 72031

Pharmacy Comments

Contract Details

Approval Date

4/11/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/18/2018
Ownership change

Contacts

Covered Entity Signing Official

Becky Blair, CFO
(870) 448-5733 Ext: 2008

Contract Pharmacy Representative

Clinton Drug
Michael Butler, Owner
(501) 620-4053

Signed By Date

4/11/2018