Covered Entity Details

CAH041321-07 BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA (Active) - information as of 5/25/2025 1:16:01 AM

Main Details

Name

BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA

Subdivision Name

Baptist Health Family Clinic - Sparkman - Baptist Health Family Clinic - Sparkman

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041321-07

Medicare Provider Number

041321

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/26/2022

Last Recertification Date

9/3/2024

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

104 West Taylor Street
Sparkman, AR 71763

Billing Address

Baptist Health Medical Center - Arkadelphia
3050 Twin Rivers Drive
Arkadelphia, AR 71923

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?
No

Shipping Addresses

Shipping Address 1

Baptist Health Medical Center - Arkadelphia
3050 Twin Rivers Drive
Arkadelphia, AR 71923

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
CAH041321-01	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Baptist Health Therapy Center - Arkadelphia	312 Professional Park Drive	Arkadelphia	AR	Active
CAH041321-02	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Baptist Health Family Clinic - Gurdon	200 East Walnut Street	Gurdon	AR	Active
CAH041321-03	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Baptist Health Family Clinic - Caddo Valley	10 Montgomery Drive	Caddo Valley	AR	Active
CAH041321-04	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Baptist Health Family Clinic - Bismarck	6679 Highway 7	Bismarck	AR	Active
CAH041321-05	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Prescott RHC	1484 West First Street North	Prescott	AR	Active
CAH041321-06	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	BAPTIST HEALTH - BH Arkadelphia Medical Clinic	2913 CYPRESS RD, STE 100	ARKADELPHIA	AR	Active
CAH041321-07	Child	CAH	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	Baptist Health Family Clinic - Sparkman - Baptist Health Family Clinic - Sparkman	104 West Taylor Street	Sparkman	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/13/2023 11:28:34 AM	9/3/2024 11:16:29 AM	9/3/2024 11:16 AM
Details	Last Recertification Date	Update	Recertification		9/13/2023 11:28:34 AM	9/13/2023 11:28 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	276414729 (AR)		10/18/2022 5:33 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427630110 (AR)		10/18/2022 5:33 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Beaulieu, Brent CFO Baptist Health 5012022017	7/26/2022 8:29 AM
Details	340B ID	Update	New Registration		CAH041321-07	7/26/2022 8:29 AM
Details	Entity Name	Update	New Registration	BAPTIST HEALTH MED CTR ARKADELPHIA	BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA	7/26/2022 8:29 AM
Details	Entity Subname	Update	New Registration	Baptist Health Family Clinic - Sparkman	Baptist Health Family Clinic - Sparkman - Baptist Health Family Clinic - Sparkman	7/26/2022 8:29 AM
Dates	Participating Approval Date	Update	New Registration		7/26/2022 8:29:42 AM	7/26/2022 8:29 AM
Details	State	Update	New Registration	Pending	Approved	7/26/2022 8:29 AM
Dates	Signed By Date	Update	New Registration		7/15/2022 7:01:25 PM	7/26/2022 8:29 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/26/2022 8:29 AM
Addresses	Main Address	Insert	New Registration		104 West Taylor Street Sparkman, AR 71763	7/15/2022 12:05 PM
Addresses	Billing Address	Insert	New Registration		Baptist Health Medical Center - Arkadelphia 3050 Twin Rivers Drive Arkadelphia, AR 71923	7/15/2022 12:05 PM
Addresses	Shipping Address	Insert	New Registration		Baptist Health Medical Center - Arkadelphia 3050 Twin Rivers Drive Arkadelphia, AR 71923	7/15/2022 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/15/2022 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		276414729	7/15/2022 12:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	7/15/2022 12:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427630110	7/15/2022 12:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	7/15/2022 12:05 PM
Contacts	Primary Contact	Insert	New Registration		Jaeger, Stefanie Sr. Reimbursement Specialist Baptist Health 5012021813	7/15/2022 12:05 PM
Contacts	Authorizing Official	Insert	New Registration		Beaulieu, Brent CFO Baptist Health 5012022017	7/15/2022 12:05 PM
Details	Assistance Received From Date	Insert	New Registration			7/15/2022 12:05 PM
Details	Assistance Received To Date	Insert	New Registration			7/15/2022 12:05 PM
Details	Last Recertification Date	Insert	New Registration			7/15/2022 12:05 PM
Details	Grant Number	Insert	New Registration			7/15/2022 12:05 PM
Details	340B ID	Insert	New Registration			7/15/2022 12:05 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2022 12:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2022 12:05 PM
Details	Medicare Provider Number	Insert	New Registration		041321	7/15/2022 12:05 PM
Details	Entity Name	Insert	New Registration		BAPTIST HEALTH MED CTR ARKADELPHIA	7/15/2022 12:05 PM
Details	NOFO Number	Insert	New Registration			7/15/2022 12:05 PM
Details	Program Code	Insert	New Registration		CAH	7/15/2022 12:05 PM
Details	Entity Subname	Insert	New Registration		Baptist Health Family Clinic - Sparkman	7/15/2022 12:05 PM
Dates	Participating Approval Date	Insert	New Registration			7/15/2022 12:05 PM
Details	State	Insert	New Registration		Pending	7/15/2022 12:05 PM
Dates	Registration Date	Insert	New Registration		7/15/2022 12:05:54 PM	7/15/2022 12:05 PM
Dates	Signed By Date	Insert	New Registration			7/15/2022 12:05 PM
Dates	Start Date	Insert	New Registration			7/15/2022 12:05 PM
Terminations	Termination Comments	Insert	New Registration			7/15/2022 12:05 PM
Terminations	Termination Date	Insert	New Registration			7/15/2022 12:05 PM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2022 12:05 PM
Terminations	Termination Reason	Insert	New Registration			7/15/2022 12:05 PM