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CALDWELL DISCOUNT DRUG
CAH041307-00 ST BERNARDS COMMUNITY HOSPITAL DBA CROSSRIDGE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ST BERNARDS COMMUNITY HOSPITAL DBA CROSSRIDGE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041307-00
Entity Address
310 S FALLS BLVD
WYNNE, AR 72396
Medicare Provider Number
041307
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CALDWELL DISCOUNT DRUG
Pharmacy Address
804 FALLS BLVD S
PO BOX 1084
WYNNE, AR 72396-3505
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GARY SPARKS, ADMINISTRATOR
(870) 208-2108
Contract Pharmacy Representative
Caldwell Discount Pharmacy
Max G Caldwell, President
(870) 238-7085
Signed By Date
1/15/2020
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