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ARKANSAS CVS PHARMACY, L.L.C.
DSH040018 BAPTIST HEALTH MEDICAL CENTER - VB
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - VB
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040018
Entity Address
211 Crawford Memorial Drive
VAN BUREN, AR 72956
Medicare Provider Number
040018
Participating Start Date
1/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ARKANSAS CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10255
2015 FAYETTEVILLE ROAD
VAN BUREN, AR 72956
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/9/2020
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