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FREEDOM PHARMACY LLC
DSH040015 MENA REGIONAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
MENA REGIONAL HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040015
Entity Address
311 NORTH MORROW
MENA, AR 71953
Medicare Provider Number
040015
Participating Start Date
7/1/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
FREEDOM PHARMACY LLC
Pharmacy Address
710 4TH ST
MENA, AR 71953
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jay Quebedeaux, CEO
(479) 394-6100 Ext: 2237
Contract Pharmacy Representative
Freedom Pharmacy
Brian Erickson, Owner
(479) 437-3089
Signed By Date
4/13/2020
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