Covered Entity Details

SCH040072-06 BHMC- STUTTGART (Active) - information as of 6/14/2025 10:09:56 AM

Main Details

Name

BHMC- STUTTGART

Subdivision Name

BAPTIST HEALTH-STUTTGART MEDICAL CLINIC - BAPTIST HEALTH-STUTTGART MEDICAL CLINIC

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH040072-06

Medicare Provider Number

040072

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/18/2024

Last Recertification Date

Contacts

Authorizing Official

Baptist Health
Brent Beaulieu, CFO
(501) 202-2017

Primary Contact

Baptist Health
Stefanie Jaeger, Sr. Reimbursement Specialist
(501) 202-1813

Addresses

Street Address

1609 NORTH MEDICAL DRIVE
Stuttgart, AR 72160

Billing Address

Baptist Health Medical Center - Stuttgart
1703 North Buerkle Road
Stuttgart, AR 72160

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
AR	201482729	1902004567

Shipping Addresses

Shipping Address 1

Baptist Health Medical Center - Stuttgart
1703 North Buerkle Road
Stuttgart, AR 72160

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH040072-01	Child	SCH	BHMC- STUTTGART	Baptist Health Family Clinic - Brinkley - Baptist Health Family Clinic - Brinkley	110 North New York Avenue	Brinkley	AR	Active
SCH040072-02	Child	SCH	BHMC- STUTTGART	Baptist Health Family Clinic - Clarendon - Baptist Health Family Clinic - Clarendon	198 South Main Street	Clarendon	AR	Active
SCH040072-03	Child	SCH	BHMC- STUTTGART	Baptist Health Family Clinic - Dewitt - Baptist Health Family Clinic - Dewitt	1703 South Whitehead Drive	Dewitt	AR	Active
SCH040072-04	Child	SCH	BHMC- STUTTGART	Baptist Health Family Clinic - Hazen - Baptist Health Family Clinic - Hazen	102 West Front Street	Hazen	AR	Active
SCH040072-05	Child	SCH	BHMC- STUTTGART	BH Stuttgart Campus Clinic - BH Stuttgart Campus Clinic	1703 North Buerkle	Stuttgart	AR	Active
SCH040072-06	Child	SCH	BHMC- STUTTGART	BAPTIST HEALTH-STUTTGART MEDICAL CLINIC - BAPTIST HEALTH-STUTTGART MEDICAL CLINIC	1609 NORTH MEDICAL DRIVE	Stuttgart	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Beaulieu, Brent CFO Baptist Health 5012022017	7/18/2024 11:45 AM
Details	340B ID	Update	New Registration		SCH040072-06	7/18/2024 11:45 AM
Details	Entity Subname	Update	New Registration	BAPTIST HEALTH-STUTTGART MEDICAL CLINIC	BAPTIST HEALTH-STUTTGART MEDICAL CLINIC - BAPTIST HEALTH-STUTTGART MEDICAL CLINIC	7/18/2024 11:45 AM
Dates	Participating Approval Date	Update	New Registration		7/18/2024 11:45:55 AM	7/18/2024 11:45 AM
Details	State	Update	New Registration	Pending	Approved	7/18/2024 11:45 AM
Dates	Signed By Date	Update	New Registration		7/11/2024 10:18:32 AM	7/18/2024 11:45 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/18/2024 11:45 AM
Addresses	Main Address	Insert	New Registration		1609 NORTH MEDICAL DRIVE Stuttgart, AR 72160	7/9/2024 2:32 PM
Addresses	Billing Address	Insert	New Registration		Baptist Health Medical Center - Stuttgart 1703 North Buerkle Road Stuttgart, AR 72160	7/9/2024 2:32 PM
Addresses	Shipping Address	Insert	New Registration		Baptist Health Medical Center - Stuttgart 1703 North Buerkle Road Stuttgart, AR 72160	7/9/2024 2:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/9/2024 2:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		201482729	7/9/2024 2:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	7/9/2024 2:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1902004567	7/9/2024 2:32 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	7/9/2024 2:32 PM
Contacts	Primary Contact	Insert	New Registration		Jaeger, Stefanie Sr. Reimbursement Specialist Baptist Health 5012021813	7/9/2024 2:32 PM
Contacts	Authorizing Official	Insert	New Registration		Beaulieu, Brent CFO Baptist Health 5012022017	7/9/2024 2:32 PM
Details	Assistance Received From Date	Insert	New Registration			7/9/2024 2:32 PM
Details	Assistance Received To Date	Insert	New Registration			7/9/2024 2:32 PM
Details	Last Recertification Date	Insert	New Registration			7/9/2024 2:32 PM
Details	Grant Number	Insert	New Registration			7/9/2024 2:32 PM
Details	340B ID	Insert	New Registration			7/9/2024 2:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/9/2024 2:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/9/2024 2:32 PM
Details	Medicare Provider Number	Insert	New Registration		040072	7/9/2024 2:32 PM
Details	Entity Name	Insert	New Registration		BHMC- STUTTGART	7/9/2024 2:32 PM
Details	NOFO Number	Insert	New Registration			7/9/2024 2:32 PM
Details	Program Code	Insert	New Registration		SCH	7/9/2024 2:32 PM
Details	Entity Subname	Insert	New Registration		BAPTIST HEALTH-STUTTGART MEDICAL CLINIC	7/9/2024 2:32 PM
Dates	Participating Approval Date	Insert	New Registration			7/9/2024 2:32 PM
Details	State	Insert	New Registration		Pending	7/9/2024 2:32 PM
Dates	Registration Date	Insert	New Registration		7/9/2024 2:32:57 PM	7/9/2024 2:32 PM
Dates	Signed By Date	Insert	New Registration			7/9/2024 2:32 PM
Dates	Start Date	Insert	New Registration			7/9/2024 2:32 PM
Terminations	Termination Comments	Insert	New Registration			7/9/2024 2:32 PM
Terminations	Termination Date	Insert	New Registration			7/9/2024 2:32 PM
Terminations	Termination Effective Date	Insert	New Registration			7/9/2024 2:32 PM
Terminations	Termination Reason	Insert	New Registration			7/9/2024 2:32 PM