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COMMUNITY CARE RX LLC
CAH041321-00 BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - ARKADELPHIA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041321-00
Entity Address
3050 TWIN RIVERS DRIVE
ARKADELPHIA, AR 71923-4299
Medicare Provider Number
041321
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
COMMUNITY CARE RX LLC
Pharmacy Address
1606 MARTIN LUTHER KING BLVD
MALVERN, AR 72104-2105
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Community Care Pharmacy
Shelyn Davis, Pharmacist
(501) 229-1446
Signed By Date
4/12/2023
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