340B Drug Pricing Program Database
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DSH040020Z ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER (Active)
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Main Details
Name
ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER
Subdivision Name
St. Bernards Dialysis- Walnut Ridge - Dialysis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH040020Z
Medicare Provider Number
040020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/23/2024
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
St Bernards Healthcare
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565
Primary Contact
St. Bernards Medical Center
James Douglas Welborn, Assistant Vice President of Pharmacy Services
(870) 207-1800
Addresses
Street Address
1051 W Free St
Walnut Ridge, AR 72476
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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