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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12912
705 W CENTER ST
GREENWOOD, AR 72936
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2021
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