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RRC040039-04 Arkansas Methodist Medical Center (Terminated)
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Main Details
Name
Arkansas Methodist Medical Center
Subdivision Name
AMMC Hines Family Medicine - Family Practice
Type
Rural Referral Center
Rural
Yes
340B ID
RRC040039-04
Medicare Provider Number
040039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2021
Participating Start Date
7/1/2021
Participating Approval Date
6/1/2021
Last Recertification Date
8/15/2023
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
1300 W Court St
Paragould, AR 72450
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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