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CITY DRUG COMPANY, INC.
RRC040039-00 Arkansas Methodist Medical Center
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Covered Entity Details
Entity Name
Arkansas Methodist Medical Center
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040039-00
Entity Address
900 W Kingshighway
Paragould, AR 72450
Medicare Provider Number
040039
Participating Start Date
4/1/2018
Last Recertification Date
8/22/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
CITY DRUG COMPANY, INC.
Pharmacy Address
1512 LINWOOD DR
PARAGOULD, AR 72450-5814
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brad Bloemer, CFO
(870) 239-7102
Contract Pharmacy Representative
City Drug
Jimmy Dodd, Owner
(870) 236-8501
Signed By Date
10/14/2020
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