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DSH040114G BAPTIST HEALTH MEDICAL CENTER - LR (Active)
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Main Details
Name
BAPTIST HEALTH MEDICAL CENTER - LR
Subdivision Name
Arkansas Cardiology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH040114G
Medicare Provider Number
040114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2013
Participating Start Date
10/1/2016
Participating Approval Date
7/19/2013
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
9501 Baptist Health Drive Suite 600
Little Rock, AR 72205
Billing Address
Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/4/15 Participated starting 10/1/2013, terminated 7/1/2014, reinstated effective 10/1/16 based on new registration submitted in July 2016
08/18/2016
8/4/15 Participated starting 10/1/2013, 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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