Contract Pharmacy Details

SMITH FAMILY PHARMACY
DSH040154 BHMC-CONWAY

Covered Entity Details

Entity Name

BHMC-CONWAY

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH040154

Entity Address

1555 EXCHANGE AVENUE
CONWAY, AR 72032

Medicare Provider Number

040154

Participating Start Date

10/1/2020

Last Recertification Date

9/12/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

SMITH FAMILY PHARMACY

Pharmacy Address

2425 DAVE WARD DR STE 602
CONWAY, AR 72034-8685

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Brent Beaulieu, CFO
(501) 202-2017

Contract Pharmacy Representative

Smith Family Pharmacy
David Smith, Owner
(501) 336-8188

Signed By Date

10/15/2020