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COMMUNITY CARE RX LLC
DSH040076 Baptist Health Medical Center - Hot Spring County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Hot Spring County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040076
Entity Address
1001 SCHNEIDER DRIVE
MALVERN, AR 72104
Medicare Provider Number
040076
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
COMMUNITY CARE RX LLC
Pharmacy Address
1606 MARTIN LUTHER KING BLVD
MALVERN, AR 72104-2105
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
Community Care Pharmacy
Shelyn Davis, Pharmacist
(501) 229-1446
Signed By Date
7/15/2020
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