340B Drug Pricing Program Database


DSH040114T BAPTIST HEALTH MEDICAL CENTER - LR (Active) - information as of 5/27/2025 3:50:45 PM

Main Details
BAPTIST HEALTH MEDICAL CENTER - LR
Heart Failure Clinic - Heart Failure Clinic
Disproportionate Share Hospital
No
DSH040114T
040114


Additional Details
Active
10/14/2020
1/1/2021
10/21/2020
9/3/2024

Contacts

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

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

Addresses

9500 Kanis Road
Suite 310
Little Rock, AR 72205

Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AR1043041051043240682
Shipping Addresses

Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH040114AChildDSHBAPTIST HEALTH MEDICAL CENTER - LRSleep Disorder Center9500 Kanis RoadLittle RockARActive
DSH040114BChildDSHBAPTIST HEALTH MEDICAL CENTER - LRBreast Center9500 Kanis RoadLittle RockARActive
DSH040114CChildDSHBaptist Health Medical Center - Little RockKidney Transplant9500 Kanis RoadLittle RockARTerminated
DSH040114DChildDSHBAPTIST HEALTH MEDICAL CENTER - LRHeart Transplant9500 Kanis RoadLittle RockARActive
DSH040114EChildDSHBAPTIST HEALTH MEDICAL CENTER - LREye Center9800 Baptist Health DriveLittle RockARActive
DSH040114GChildDSHBAPTIST HEALTH MEDICAL CENTER - LRArkansas Cardiology Clinic9501 Baptist Health Drive Suite 600Little RockARActive
DSH040114JChildDSHBAPTIST HEALTH MEDICAL CENTER - LRInfusion Therapy9600 Baptist Health Drive Suite 330Little RockARTerminated
DSH040114KChildDSHBAPTIST HEALTH MEDICAL CENTER - LRMRI9500 Kanis RoadLittle RockARActive
DSH040114LChildDSHBAPTIST HEALTH MEDICAL CENTER - LRVein Center9501 Baptist Health Drive Suite 830Little RockARTerminated
DSH040114MChildDSHBAPTIST HEALTH MEDICAL CENTER - LRPediatric Afterhour Clinic9601 Baptist Health DriveLittle RockARTerminated
DSH040114NChildDSHBAPTIST HEALTH MEDICAL CENTER - LRVAD9500 Kanis RoadLittle RockARActive
DSH040114PChildDSHBAPTIST HEALTH MEDICAL CENTER - LRBAPTIST HEALTH / Outpatient Imaging Center9101 KANIS RDLITTLE ROCKARActive
DSH040114QChildDSHBAPTIST HEALTH MEDICAL CENTER - LRBH Heart Inst-Valve Clinic9500 Kanis RoadLittle RockARTerminated
DSH040114RChildDSHBAPTIST HEALTH MEDICAL CENTER - LRBH Employee Clinic9600 Baptist Health DriveLittle RockARActive
DSH040114SChildDSHBAPTIST HEALTH MEDICAL CENTER - LRBH Gastroenterology Center - BH Gastroenterology Center9501 Baptist Health DriveLittle RockARActive
DSH040114TChildDSHBAPTIST HEALTH MEDICAL CENTER - LRHeart Failure Clinic - Heart Failure Clinic9500 Kanis RoadLittle RockARActive
DSH040114UChildDSHBAPTIST HEALTH MEDICAL CENTER - LRLR INFUSION THERAPY - LR INFUSION THERAPY9500 Kanis RoadLittle RockARActive
DSH040114VChildDSHBAPTIST HEALTH MEDICAL CENTER - LROncology Clinic - Oncology Clinic9500 Kanis RoadLittle RockARActive
DSH040114WChildDSHBAPTIST HEALTH MEDICAL CENTER - LRNeurology Clinic - Neurology Clinic9600 Baptist Health DriveLittle RockARActive
DSH040114XChildDSHBAPTIST HEALTH MEDICAL CENTER - LRGastroenterology Clinic - Gastroenterology Clinic9501 Baptist Health DriveLittle RockARActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/13/2023 11:28:08 AM9/3/2024 11:09:02 AM9/3/2024 11:09 AM
DetailsLast Recertification DateUpdateRecertification9/12/2022 12:30:51 PM9/13/2023 11:28:08 AM9/13/2023 11:28 AM
DetailsLast Recertification DateUpdateRecertification9/3/2021 4:45:33 PM9/12/2022 12:30:51 PM9/12/2022 12:30 PM
DetailsLast Recertification DateUpdateRecertification 9/3/2021 4:45:33 PM9/3/2021 4:45 PM
DetailsStateUpdate ApprovedActive1/1/2021 12:01 AM
ContactsSigned ByInsertNew Registration Beaulieu, Brent CFO Baptist Health 501202201710/21/2020 8:10 AM
Details340B IDUpdateNew Registration DSH040114T10/21/2020 8:10 AM
DetailsEntity SubnameUpdateNew RegistrationHeart Failure ClinicHeart Failure Clinic - Heart Failure Clinic10/21/2020 8:10 AM
DatesParticipating Approval DateUpdateNew Registration 10/21/2020 8:10:17 AM10/21/2020 8:10 AM
DetailsStateUpdateNew RegistrationPendingApproved10/21/2020 8:10 AM
DatesSigned By DateUpdateNew Registration 10/20/2020 6:48:16 PM10/21/2020 8:10 AM
DatesStart DateUpdateNew Registration 1/1/2021 12:00:00 AM10/21/2020 8:10 AM
AddressesMain AddressInsertNew Registration  9500 Kanis Road Suite 310 Little Rock, AR 7220510/14/2020 4:40 PM
AddressesBilling AddressInsertNew Registration Baptist Health Medical Center - Little Rock 9601 Baptist Health Drive Little Rock, AR 7220510/14/2020 4:40 PM
AddressesShipping AddressInsertNew Registration Baptist Health Medical Center - Little Rock 9601 Baptist Health Drive Little Rock, AR 7220510/14/2020 4:40 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/14/2020 4:40 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 10430410510/14/2020 4:40 PM
Medicaid BillingMedicaid: StateInsertNew Registration AR10/14/2020 4:40 PM
Medicaid BillingNPI: NumberInsertNew Registration 104324068210/14/2020 4:40 PM
Medicaid BillingNPI: StateInsertNew Registration AR10/14/2020 4:40 PM
ContactsPrimary ContactInsertNew Registration Jaeger, Stefanie Sr. Reimbursement Specialist Baptist Health 501202181310/14/2020 4:40 PM
ContactsAuthorizing OfficialInsertNew Registration Beaulieu, Brent CFO Baptist Health 501202201710/14/2020 4:40 PM
DetailsAssistance Received From DateInsertNew Registration  10/14/2020 4:40 PM
DetailsAssistance Received To DateInsertNew Registration  10/14/2020 4:40 PM
DetailsLast Recertification DateInsertNew Registration  10/14/2020 4:40 PM
DetailsGrant NumberInsertNew Registration  10/14/2020 4:40 PM
Details340B IDInsertNew Registration  10/14/2020 4:40 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/14/2020 4:40 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/14/2020 4:40 PM
DetailsMedicare Provider NumberInsertNew Registration 04011410/14/2020 4:40 PM
DetailsEntity NameInsertNew Registration BAPTIST HEALTH MEDICAL CENTER - LR10/14/2020 4:40 PM
DetailsNOFO NumberInsertNew Registration  10/14/2020 4:40 PM
DetailsProgram CodeInsertNew Registration DSH10/14/2020 4:40 PM
DetailsEntity SubnameInsertNew Registration Heart Failure Clinic10/14/2020 4:40 PM
DatesParticipating Approval DateInsertNew Registration  10/14/2020 4:40 PM
DetailsStateInsertNew Registration Pending10/14/2020 4:40 PM
DatesRegistration DateInsertNew Registration 10/14/2020 4:40:54 PM10/14/2020 4:40 PM
DatesSigned By DateInsertNew Registration  10/14/2020 4:40 PM
DatesStart DateInsertNew Registration  10/14/2020 4:40 PM
TerminationsTermination CommentsInsertNew Registration  10/14/2020 4:40 PM
TerminationsTermination DateInsertNew Registration  10/14/2020 4:40 PM
TerminationsTermination Effective DateInsertNew Registration  10/14/2020 4:40 PM
TerminationsTermination ReasonInsertNew Registration  10/14/2020 4:40 PM