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CALDWELL DISCOUNT DRUG
DSH040020 ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040020
Entity Address
225 East Washington AVENUE
JONESBORO, AR 72401
Medicare Provider Number
040020
Participating Start Date
7/1/2006
Last Recertification Date
9/4/2024
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
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565
Contract Pharmacy Representative
Caldwell Discount Pharmacy
Max G Caldwell, President
(870) 238-7085
Signed By Date
1/15/2020
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