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ANOVORX GROUP, 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
ANOVORX GROUP, LLC
Pharmacy Address
ANOVORX GROUP, LLC
1710 SHELBY OAKS DR N
STE 1
MEMPHIS, TN 38134-7403
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
HARRY HUTCHISON, CFO
(870) 972-4565
Contract Pharmacy Representative
AnovoRx Group, LLC
Jon Peters, President
(901) 201-5484
Signed By Date
7/14/2016
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