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LUMICERA HEALTH SERVICES, LLC
DSH040055 Baptist Health - Fort Smith
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Covered Entity Details
Entity Name
Baptist Health - Fort Smith
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040055
Entity Address
1001 TOWSON AVE
FORT SMITH, AR 72901
Medicare Provider Number
040055
Participating Start Date
10/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
LUMICERA HEALTH SERVICES, LLC
Pharmacy Address
310 INTEGRITY DRIVE
MADISON, WI 53717-1499
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Lumicera
Eric Huckins, Manager
(608) 716-2667
Signed By Date
4/12/2023
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