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DSH040114J BAPTIST HEALTH MEDICAL CENTER - LR (Terminated)
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Main Details
Name
BAPTIST HEALTH MEDICAL CENTER - LR
Subdivision Name
Infusion Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH040114J
Medicare Provider Number
040114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/4/2015
Last Recertification Date
Termination Date
Termination Reason
10/1/2015
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
9600 Baptist Health Drive Suite 330
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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