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DSH040114C Baptist Health Medical Center - Little Rock (Terminated)
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Main Details
Name
Baptist Health Medical Center - Little Rock
Subdivision Name
Kidney Transplant
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH040114C
Medicare Provider Number
040114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
10/1/2015
Participating Approval Date
5/3/2013
Last Recertification Date
8/24/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Baptist Health
Brent Beaulieu, CFO
(501) 202-2017
Primary Contact
David Cobb, Pharmacy Director
(501) 202-2126
Addresses
Street Address
9500 Kanis Road
Little Rock, AR 72205
Billing Address
Baptist Health Medical Center - Little Rock
9601 Interstate 630 Exit 7
Little Rock, AR 72205
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/4/15 Participated starting 7/1/2013, terminated 7/1/2014 due to "DSH percentage below statutory minimum." Reinstated based on new registration submitted in July 2015.
08/04/2015
May 2025
May 2025
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