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ANDERSON'S DISCOUNT PHARMACY
DSH040055 Baptist Health - Fort Smith
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Covered Entity Details
Entity Name
Baptist Health - Fort Smith
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040055
Entity Address
1001 TOWSON AVE
FORT SMITH, AR 72901
Medicare Provider Number
040055
Participating Start Date
10/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ANDERSON'S DISCOUNT PHARMACY
Pharmacy Address
700 LEXINGTON AVE
FORT SMITH, AR 72901-4738
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Anderson's Discount Pharmacy
Amy Gibbons, Pharmacist in charge
(479) 782-2881
Signed By Date
7/15/2020
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