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AMERITA, INC.
DSH040016 UNIVERSITY OF ARKANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ARKANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040016
Entity Address
4301 WEST MARKHAM ST
Slot 571
LITTLE ROCK, AR 72205
Medicare Provider Number
040016
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
AMERITA, INC.
Pharmacy Address
2709 SE OTIS CORLEY DR.
STE 19
BENTONVILLE, AR 72712
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey J Cook, Chief Pharmacy Officer
(501) 686-6690
Contract Pharmacy Representative
Amerita, Inc.
Ivan Menendez, Director of Pharmacy
(253) 677-0029
Signed By Date
4/14/2022
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