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LIVE+WELL PHARMACY
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
LIVE+WELL PHARMACY
Pharmacy Address
LOWELL PHARMACY
3500 SW REGIONAL AIRPORT BLVD STE 2
49 LANCASTER DR
BENTONVILLE, AR 72713
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAUL GREGORY TAYLOR, CEO
(417) 837-2012
Contract Pharmacy Representative
LIVE + WELL PHARMACY
JAMES GARLAND, PIC
(479) 271-9355
Signed By Date
4/14/2022
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