Covered Entity Details

DSH040055R Baptist Health - Fort Smith (Active) - information as of 6/14/2025 10:09:13 AM

Main Details

Name

Baptist Health - Fort Smith

Subdivision Name

BAPTIST HEALTH FAMILY CLINIC-ALMA - Baptist Health Family Clinic - Alma

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH040055R

Medicare Provider Number

040055

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/19/2024

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

937 HIGHWAY 64 E
ALMA, AR 72921-7382

Billing Address

Baptist Health - Fort Smith
1001 TOWSON AVE
Fort Smith, AR 72901

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	233506105	1710463146
OK	200827000A	1710463146

Shipping Addresses

Shipping Address 1

Baptist Health - Fort Smith
1001 TOWSON AVE
Fort Smith, AR 72901

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
DSH040055E	Child	DSH	Baptist Health - Fort Smith	BH Laboratory - Fort Smith	1500 Dodson Avenue	Fort Smith	AR	Active
DSH040055F	Child	DSH	Baptist Health - Fort Smith	BH Women's Center - Fort Smith	1500 Dodson Avenue	Fort Smith	AR	Active
DSH040055G	Child	DSH	Baptist Health - Fort Smith	BH Radiation Oncology - Fort Smith	1502 Dodson Avenue	Fort Smith	AR	Active
DSH040055H	Child	DSH	Baptist Health - Fort Smith	BH Therapy Center - Fort Smith	624 Towson Avenue	Fort Smith	AR	Active
DSH040055J	Child	DSH	Baptist Health - Fort Smith	BH Imaging Center - Fort Smith	1500 Dodson Avenue	Fort Smith	AR	Active
DSH040055K	Child	DSH	Baptist Health - Fort Smith	BH PREADMISSION TESTING CENTER	1001 Towson Avenue	FORT SMITH	AR	Terminated
DSH040055L	Child	DSH	Baptist Health - Fort Smith	BH-FS CARDIAC REHAB	810 LEXINGTON AVE	FORT SMITH	AR	Active
DSH040055M	Child	DSH	Baptist Health - Fort Smith	Fort Smith Cardiology Clinic	1500 Dodson Avenue	Fort Smith	AR	Active
DSH040055N	Child	DSH	Baptist Health - Fort Smith	BH Lung Center - BH Lung Center	1001 Towson Avenue	Fort Smith	AR	Active
DSH040055P	Child	DSH	Baptist Health - Fort Smith	BH Cancer Center - BH Cancer Center	1001 Towson Avenue	Fort Smith	AR	Active
DSH040055Q	Child	DSH	Baptist Health - Fort Smith	BH Specialty Clinic FS - BH Specialty Clinic FS	1001 Towson Avenue	Fort Smith	AR	Active
DSH040055R	Child	DSH	Baptist Health - Fort Smith	BAPTIST HEALTH FAMILY CLINIC-ALMA - Baptist Health Family Clinic - Alma	937 HIGHWAY 64 E	ALMA	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	7/19/2024 12:38 PM
Details	340B ID	Update	New Registration		DSH040055R	7/19/2024 12:38 PM
Details	Entity Name	Update	New Registration	BAPTIST HEALTH MEDICAL CENTER - FS	Baptist Health - Fort Smith	7/19/2024 12:38 PM
Details	Entity Subname	Update	New Registration	BAPTIST HEALTH FAMILY CLINIC-ALMA	BAPTIST HEALTH FAMILY CLINIC-ALMA - Baptist Health Family Clinic - Alma	7/19/2024 12:38 PM
Dates	Participating Approval Date	Update	New Registration		7/19/2024 12:38:36 PM	7/19/2024 12:38 PM
Details	State	Update	New Registration	Pending	Approved	7/19/2024 12:38 PM
Dates	Signed By Date	Update	New Registration		7/9/2024 7:46:26 PM	7/19/2024 12:38 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/19/2024 12:38 PM
Addresses	Main Address	Insert	New Registration		937 HIGHWAY 64 E ALMA, AR 72921-7382	7/9/2024 7:05 PM
Addresses	Billing Address	Insert	New Registration		Baptist Health - Fort Smith 1001 TOWSON AVE Fort Smith, AR 72901	7/9/2024 7:05 PM
Addresses	Shipping Address	Insert	New Registration		Baptist Health - Fort Smith 1001 TOWSON AVE Fort Smith, AR 72901	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		233506105	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200827000A	7/9/2024 7:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	7/9/2024 7:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1710463146	7/9/2024 7:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	7/9/2024 7:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1710463146	7/9/2024 7:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		OK	7/9/2024 7:05 PM
Contacts	Primary Contact	Insert	New Registration		Jaeger, Stefanie Sr. Reimbursement Specialist Baptist Health 5012021813	7/9/2024 7:05 PM
Contacts	Authorizing Official	Insert	New Registration		Beaulieu, Brent CFO Baptist Health 5012022017	7/9/2024 7:05 PM
Details	Assistance Received From Date	Insert	New Registration			7/9/2024 7:05 PM
Details	Assistance Received To Date	Insert	New Registration			7/9/2024 7:05 PM
Details	Last Recertification Date	Insert	New Registration			7/9/2024 7:05 PM
Details	Grant Number	Insert	New Registration			7/9/2024 7:05 PM
Details	340B ID	Insert	New Registration			7/9/2024 7:05 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/9/2024 7:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/9/2024 7:05 PM
Details	Medicare Provider Number	Insert	New Registration		040055	7/9/2024 7:05 PM
Details	Entity Name	Insert	New Registration		BAPTIST HEALTH MEDICAL CENTER - FS	7/9/2024 7:05 PM
Details	NOFO Number	Insert	New Registration			7/9/2024 7:05 PM
Details	Program Code	Insert	New Registration		DSH	7/9/2024 7:05 PM
Details	Entity Subname	Insert	New Registration		BAPTIST HEALTH FAMILY CLINIC-ALMA	7/9/2024 7:05 PM
Dates	Participating Approval Date	Insert	New Registration			7/9/2024 7:05 PM
Details	State	Insert	New Registration		Pending	7/9/2024 7:05 PM
Dates	Registration Date	Insert	New Registration		7/9/2024 7:05:06 PM	7/9/2024 7:05 PM
Dates	Signed By Date	Insert	New Registration			7/9/2024 7:05 PM
Dates	Start Date	Insert	New Registration			7/9/2024 7:05 PM
Terminations	Termination Comments	Insert	New Registration			7/9/2024 7:05 PM
Terminations	Termination Date	Insert	New Registration			7/9/2024 7:05 PM
Terminations	Termination Effective Date	Insert	New Registration			7/9/2024 7:05 PM
Terminations	Termination Reason	Insert	New Registration			7/9/2024 7:05 PM