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PAT'S SUPER V DRUGSTORE INC
DSH040020 ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040020
Entity Address
225 East Washington AVENUE
JONESBORO, AR 72401
Medicare Provider Number
040020
Participating Start Date
7/1/2006
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
PAT'S SUPER V DRUGSTORE INC
Pharmacy Address
1000 E MATTHEWS AVE STE A
JONESBORO, AR 72401-4344
Pharmacy Comments
Contract Details
Approval Date
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565
Contract Pharmacy Representative
Super V Drug
Melanie Weathers, Pharmacist In charge
(870) 972-6470
Signed By Date
4/7/2022
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