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PPG STORE 3, LLC
DSH040016 UNIVERSITY OF ARKANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ARKANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040016
Entity Address
4301 WEST MARKHAM ST
Slot 571
LITTLE ROCK, AR 72205
Medicare Provider Number
040016
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PPG STORE 3, LLC
Pharmacy Address
DBA HEARTLAND PHARMACY MARKHAM
11414 W MARKHAM ST
SUITE D
LITTLE ROCK, AR 72211
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy E Hill, Chief Operating Officer
(501) 686-8955
Contract Pharmacy Representative
Heartland Pharmacy
Clint S Boone, Pharmacist Co-owner
(501) 904-4299
Signed By Date
4/15/2020
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