Covered Entity Details

CAH041312-05 BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS (Terminated) - information as of 6/22/2025 12:08:37 AM

Main Details

Name

BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS

Subdivision Name

Fairfield Bay RHC

Type

Critical Access Hospital

Rural

340B ID

CAH041312-05

Medicare Provider Number

041312

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/1/2016

Participating Start Date

10/1/2016

Participating Approval Date

7/13/2016

Last Recertification Date

11/29/2017

Termination Date
Termination Reason

10/1/2018
Site closure

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

110 Village Place, Suite 2B
Fairfield Bay, AR 72088

Billing Address

Baptist Health Medical Center - Heber Springs
1800 Bypass Road
Heber Springs, AR 72543

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	130609105

Shipping Addresses

Shipping Address 1

Baptist Health Medical Center - Heber Springs
1800 Bypass Road
Heber Springs, AR 72543

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
CAH041312-01	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	Baptist Health Therapy Clinic - Heber Springs	1415 Highway 25B	Heber Springs	AR	Active
CAH041312-02	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	Baptist Health Therapy Center - Fairfield Bay	381 Dave Creek Parkway	Fairfield Bay	AR	Terminated
CAH041312-03	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	Baptist Health Family Clinic - Greers Ferry	8544 Edgemont Road	Greers Ferry	AR	Active
CAH041312-04	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	Baptist Health Family Clinic - Heber Springs	1415 Hwy 25B	Heber Springs	AR	Active
CAH041312-05	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	Fairfield Bay RHC	110 Village Place, Suite 2B	Fairfield Bay	AR	Terminated
CAH041312-06	Child	CAH	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	BH Heber Springs - Campus Clinic	1800 Bypass Road	Heber Springs	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Beaulieu, Brent VP of Finance Baptist Health 5012022017	Beaulieu, Brent CFO Baptist Health 5012022017	4/5/2019 3:34 PM
Contacts	Signed By	Update	Profile Change Request	Beaulieu, Brent VP of Finance Baptist Health 5012022017	Beaulieu, Brent CFO Baptist Health 5012022017	4/5/2019 3:34 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		5/31/2018 12:00:00 AM	9/3/2018 7:47 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/3/2018 7:47 AM
Terminations	Termination Date	Update	Recertification		10/1/2018 12:00:00 AM	9/3/2018 7:47 AM
Terminations	Termination Effective Date	Update	Recertification		5/31/2018 12:00:00 AM	9/3/2018 7:47 AM
Terminations	Termination Reason	Update	Recertification		Site closure	9/3/2018 7:47 AM
Details	Last Recertification Date	Update	Recertification		11/29/2017 4:21:22 PM	11/29/2017 4:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/27/2017 4:32 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		130609105	9/27/2017 4:32 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	9/27/2017 4:32 PM
Contacts	Primary Contact	Insert	Change Request		Jaeger, Stefanie Sr. Reimbursement Specialist Baptist Health 5012021813	9/26/2017 6:14 PM
Contacts	Authorizing Official	Update		Beaulieu, Brent VP of Finance 5012022017	Beaulieu, Brent VP of Finance Baptist Health 5012022017	9/26/2017 5:56 PM
Contacts	Signed By	Update		Beaulieu, Brent VP of Finance 5012022017	Beaulieu, Brent VP of Finance Baptist Health 5012022017	9/26/2017 5:56 PM
Contacts	Authorizing Official	Insert			Beaulieu, Brent VP of Finance 5012022017	7/26/2017 12:26 PM
Contacts	Signed By	Insert			Beaulieu, Brent VP of Finance 5012022017	7/26/2017 12:26 PM
Addresses	Main Address	Insert			110 Village Place, Suite 2B Fairfield Bay, AR 72088	7/13/2016 11:22 AM
Addresses	Billing Address	Insert			Baptist Health Medical Center - Heber Springs 1800 Bypass Road Heber Springs, AR 72543	7/13/2016 11:22 AM
Addresses	Shipping Address	Insert			Baptist Health Medical Center - Heber Springs 1800 Bypass Road Heber Springs, AR 72543	7/13/2016 11:22 AM
Dates	Participating Approval Date	Update			7/13/2016 12:00:00 AM	7/13/2016 11:20 AM
Details	State	Update		Pending	Active	7/13/2016 11:20 AM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	7/13/2016 11:20 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_60813	CAH041312-05	7/7/2016 1:35 PM
Details	Entity Name	Update		BHMC-HEBER SPRINGS	BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS	7/7/2016 1:35 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_60813	7/1/2016 2:50 PM
Details	Last Recertification Date	Insert				7/1/2016 2:50 PM
Details	Grant Number	Insert				7/1/2016 2:50 PM
Details	340B ID	Insert				7/1/2016 2:50 PM
Details	Is Authorizing Official EHB Data	Insert				7/1/2016 2:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/1/2016 2:50 PM
Details	Medicare Provider Number	Insert			041312	7/1/2016 2:50 PM
Details	Entity Name	Insert			BHMC-HEBER SPRINGS	7/1/2016 2:50 PM
Details	Program Code	Insert			CAH	7/1/2016 2:50 PM
Details	Entity Subname	Insert			Fairfield Bay RHC	7/1/2016 2:50 PM
Dates	Participating Approval Date	Insert				7/1/2016 2:50 PM
Details	State	Insert			Pending	7/1/2016 2:50 PM
Dates	Registration Date	Insert			7/1/2016 12:00:00 AM	7/1/2016 2:50 PM
Dates	Signed By Date	Insert			7/1/2016 12:00:00 AM	7/1/2016 2:50 PM
Dates	Start Date	Insert				7/1/2016 2:50 PM
Terminations	Termination Comments	Insert				7/1/2016 2:50 PM
Terminations	Termination Date	Insert				7/1/2016 2:50 PM
Terminations	Termination Effective Date	Insert				7/1/2016 2:50 PM
Terminations	Termination Reason	Insert				7/1/2016 2:50 PM