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MEDI SHOP PHARMACY, L.L.C.
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
MEDI SHOP PHARMACY, L.L.C.
Pharmacy Address
204 HIGHWAY 71 S
MENA, AR 71953-4638
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Jay Quebedeaux, CEO
(479) 394-6100 Ext: 2237
Contract Pharmacy Representative
Medi Shop Pharmacy
Bob Geyer, Owner
(479) 394-3254
Signed By Date
4/14/2020
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