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WILSON PHARMACY LLC
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
WILSON PHARMACY LLC
Pharmacy Address
5 N JEFFERSON STREET
P O BOX 96
WILSON, AR 72395
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
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
Wilson Pharmacy
Ashley Massey, Pharmacist In Charge
(870) 561-1500
Signed By Date
4/13/2022
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