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DAVIDSON DRUG, 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
DAVIDSON DRUG, LLC
Pharmacy Address
1238A HIGHWAY 62 412
HIGHLAND, AR 72542-9468
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/7/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565
Contract Pharmacy Representative
Davidson Drug
Ken Davidson, Co-owner
(870) 955-1022
Signed By Date
1/17/2023
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