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SULLIVAN PHARMACY
DSH040017 NORTH ARKANSAS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH ARKANSAS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040017
Entity Address
620 NORTH MAIN STREET
HARRISON, AR 72601
Medicare Provider Number
040017
Participating Start Date
10/1/2010
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
SULLIVAN PHARMACY
Pharmacy Address
BUNDY FAMILY PHARMACY, LLC
731 N MAIN ST STE B
HARRISON, AR 72601
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sammie Cribbs, Chief Executive Officer
(870) 414-5159
Contract Pharmacy Representative
Sullivan Pharmacy
Addie Bundy, Owner
(870) 741-2119
Signed By Date
10/12/2022
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