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RRC040039-00 Arkansas Methodist Medical Center (Terminated)
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Main Details
Name
Arkansas Methodist Medical Center
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC040039-00
Medicare Provider Number
040039
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
8/22/2023
Termination Date
Termination Reason
1/1/2024
Change of covered entity type
Contacts
Authorizing Official
Arkansas Methodist Medical Center
Staci J Williams, CFO
(870) 239-7105
Primary Contact
Arkansas Methodist Medical Center
Stan Carmack, Pharm.D.
(870) 239-7861
Addresses
Street Address
900 W Kingshighway
Paragould, AR 72450
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Initial start date 7/1/2013, Termination 1/1/2018, reinstate 4/1/2018
01/16/2018
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