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PPG STORE 7 LLC DBA HEARTLAND PHARMACY A
CAH041321-00 BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041321-00
Entity Address
3050 TWIN RIVERS DRIVE
ARKADELPHIA, AR 71923-4299
Medicare Provider Number
041321
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PPG STORE 7 LLC DBA HEARTLAND PHARMACY A
Pharmacy Address
102 N 27TH ST
ARKADELPHIA, AR 71923
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Heartland Pharmacy
Clint S Boone, Pharmacist Co-owner
(501) 904-4299
Signed By Date
1/15/2021
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