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IVY FAMILY PHARMACY, INC.
CAH041312-00 BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041312-00
Entity Address
1800 BYPASS ROAD
HEBER SPRINGS, AR 72543
Medicare Provider Number
041312
Participating Start Date
9/27/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
IVY FAMILY PHARMACY, INC.
Pharmacy Address
DBA FAMILY DISCO PHARMACY
120 S 4TH ST
HEBER SPRINGS, AR 72543-7254
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Family Disco Pharmacy
Jamie Ivy, Owner
(501) 362-5853
Signed By Date
1/17/2023
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