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PPG STORE 2 LLC
CAH041331-00 OZARKS COMMUNITY HOSPITAL OF GRAVETT
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Covered Entity Details
Entity Name
OZARKS COMMUNITY HOSPITAL OF GRAVETT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041331-00
Entity Address
1101 JACKSON ST SW
GRAVETTE, AR 72736-9121
Medicare Provider Number
041331
Participating Start Date
4/1/2022
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
PPG STORE 2 LLC
Pharmacy Address
DBA HEARTLAND PHARMACY GENTRY
560 S GENTRY BLVD
GENTRY, AR 72734
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAUL GREGORY TAYLOR, CEO
(417) 837-2012
Contract Pharmacy Representative
Heartland Pharmacy
Clint S Boone, Pharmacist Co-owner
(501) 904-4299
Signed By Date
1/18/2022
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