| Details | Last Recertification Date | Update | Recertification | 9/8/2023 1:25:47 PM | 9/4/2024 1:07:00 PM | 9/4/2024 1:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 5/31/2024 2:01 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 318625105 | 5/31/2024 2:01 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | AR | 5/31/2024 2:01 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1962283192 | 5/31/2024 2:01 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | AR | 5/31/2024 2:01 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 196170105 (AR) | | 12/13/2023 7:51 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1023363348 (AR) | | 12/13/2023 7:51 AM |
| Contacts | Primary Contact | Update | Change Request | Hill, Brannon
Director of Pharmacy
Drew Memorial Hospital
8704603523 | Jaeger, Stefanie
Sr. Reimbursement Specialist
Baptist Health
5012021813 | 12/13/2023 7:51 AM |
| Contacts | Authorizing Official | Update | Change Request | Barrilleaux, Scott
CEO
Drew Memorial
8704603589 | Beaulieu, Brent
CFO
Baptist Health
5012022017 | 12/13/2023 7:51 AM |
| Details | Entity Name | Update | Change Request | DREW MEMORIAL HOSPITAL, INC. | Baptist Health Medical Center - Drew County | 12/13/2023 7:51 AM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2022 7:18:29 AM | 9/8/2023 1:25:47 PM | 9/8/2023 1:25 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2021 2:29:03 PM | 9/14/2022 7:18:29 AM | 9/14/2022 7:18 AM |
| Contacts | Primary Contact | Update | Change Request | Gage, Kacie
DOP
Drew Memorial Health System
8704603523 | Hill, Brannon
Director of Pharmacy
Drew Memorial Hospital
8704603523 | 8/25/2021 10:03 AM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2020 9:09:29 AM | 8/24/2021 2:29:03 PM | 8/24/2021 2:29 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | AR | 9/3/2020 9:09 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 10:42:52 AM | 9/3/2020 9:09:29 AM | 9/3/2020 9:09 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2018 9:55:58 AM | 8/26/2019 10:42:52 AM | 8/26/2019 10:42 AM |
| Details | Last Recertification Date | Update | Recertification | 11/8/2017 12:05:42 PM | 8/17/2018 9:55:58 AM | 8/17/2018 9:55 AM |
| Contacts | Primary Contact | Update | Recertification | Yeh, MeiLien
DOP
8704603523 | Gage, Kacie
DOP
Drew Memorial Health System
8704603523 | 11/8/2017 12:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2016 12:00:00 AM | 11/8/2017 12:05:42 PM | 11/8/2017 12:05 PM |
| Contacts | Authorizing Official | Update | | Barrilleaux, Scott
CEO
8704603589 | Barrilleaux, Scott
CEO
Drew Memorial
8704603589 | 10/11/2017 10:09 AM |
| Contacts | Authorizing Official | Update | | CLARK, SHANNON
CFO
8704603569 | Barrilleaux, Scott
CEO
8704603589 | 8/9/2017 2:44 PM |
| Addresses | Main Address | Insert | | |
778 SCOGIN DRIVE
MONTICELLO, AR 71655 | 6/15/2017 9:46 AM |
| Contacts | Primary Contact | Update | | Meek, Craig L.
DOP
8704603567 | Yeh, MeiLien
DOP
8704603523 | 6/15/2017 9:46 AM |
| Contacts | Primary Contact | Insert | | | Meek, Craig L.
DOP
8704603567 | 8/24/2016 1:22 PM |
| Details | Last Recertification Date | Update | | 8/6/2015 12:00:00 AM | 8/24/2016 12:00:00 AM | 8/24/2016 1:22 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/29/2016 2:19 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 196170105 | 2/29/2016 2:19 PM |
| Medicaid Billing | Medicaid: State | Insert | | | AR | 2/29/2016 2:19 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1023363348 | 2/29/2016 2:19 PM |
| Details | Last Recertification Date | Update | | 8/20/2014 12:00:00 AM | 8/6/2015 12:00:00 AM | 8/6/2015 10:11 AM |
| Details | Last Recertification Date | Update | | 9/5/2013 12:00:00 AM | 8/20/2014 12:00:00 AM | 8/20/2014 12:02 PM |
| Contacts | Authorizing Official | Insert | | | CLARK, SHANNON
CFO
8704603569 | 7/23/2014 3:02 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/5/2013 12:00:00 AM | 9/5/2013 5:30 PM |
| Details | Entity Name | Update | | DREW COUNTY MEMORIAL HOSPITAL | DREW MEMORIAL HOSPITAL, INC. | 4/3/2013 10:32 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/2/2012 7:56 AM |
| Details | Last Recertification Date | Insert | | | | 8/16/2010 1:35 PM |
| Details | Grant Number | Insert | | | | 8/16/2010 1:35 PM |
| Details | 340B ID | Insert | | | DSH040051 | 8/16/2010 1:35 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/16/2010 1:35 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/16/2010 1:35 PM |
| Details | Medicare Provider Number | Insert | | | 040051 | 8/16/2010 1:35 PM |
| Details | Entity Name | Insert | | | DREW COUNTY MEMORIAL HOSPITAL | 8/16/2010 1:35 PM |
| Details | Program Code | Insert | | | DSH | 8/16/2010 1:35 PM |
| Details | Entity Subname | Insert | | | | 8/16/2010 1:35 PM |
| Dates | Participating Approval Date | Insert | | | 6/15/2010 12:00:00 AM | 8/16/2010 1:35 PM |
| Details | State | Insert | | | Active | 8/16/2010 1:35 PM |
| Dates | Registration Date | Insert | | | 6/7/2010 12:00:00 AM | 8/16/2010 1:35 PM |
| Dates | Signed By Date | Insert | | | 5/24/2010 12:00:00 AM | 8/16/2010 1:35 PM |
| Dates | Start Date | Insert | | | 7/1/2010 12:00:00 AM | 8/16/2010 1:35 PM |
| Terminations | Termination Comments | Insert | | | | 8/16/2010 1:35 PM |
| Terminations | Termination Date | Insert | | | | 8/16/2010 1:35 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/16/2010 1:35 PM |
| Terminations | Termination Reason | Insert | | | | 8/16/2010 1:35 PM |
| Details | Comments Public | Insert | | | 8/16/10 NPI ADDED | 8/16/2010 1:35 PM |