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CONWAY OUTPATIENT PHARMACY
DSH040029 CONWAY REGIONAL MEDICAL CENTER INC
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Covered Entity Details
Entity Name
CONWAY REGIONAL MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040029
Entity Address
2302 COLLEGE AVENUE
CONWAY, AR 72034
Medicare Provider Number
040029
Participating Start Date
10/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CONWAY OUTPATIENT PHARMACY
Pharmacy Address
2180 ADA AVE STE 100
CONWAY, AR 72034-4916
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Reed, VP of Clinical Support Services/CIO
(501) 513-5152
Contract Pharmacy Representative
Stanley & Turner Drug Company
Greg Turner, Vice President
(501) 305-4108
Signed By Date
10/8/2021
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