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RRC040027-00 BAXTER REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
BAXTER REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC040027-00
Medicare Provider Number
040027
Additional Details
Current Program Status
Active
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/17/2019
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Baxter Regional Medical Center
Paul Ryan Killian, Director of Pharmacy
(870) 508-1377
Primary Contact
Baxter Regional Medical Center
Dallas Bryan, 340B Analyst
(870) 508-1370
Addresses
Street Address
624 HOSPITAL DRIVE
MOUNTAIN HOME, AR 72653
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 7/1/2019. Terminated 10/1/2019. Reinstated 1/1/2020.
10/17/2019
Participated starting 10/1/2017, terminated 7/1/2018. Reinstated 7/1/2019.
04/23/2019
April 2025
April 2025
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