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UAMS OUTPATIENT PHARMACY
DSH040114 BAPTIST HEALTH MEDICAL CENTER - LR
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - LR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040114
Entity Address
9601 Baptist Health Drive
LITTLE ROCK, AR 72205
Medicare Provider Number
040114
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
UAMS OUTPATIENT PHARMACY
Pharmacy Address
4301 W MARKHAM ST
SLOT 547-10
LITTLE ROCK, AR 72205-7101
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
UNIVERSITY OF ARKANSAS SYSTEM DBA UAMS OUTPATIENT PHARMACY
Amanda George, VP of Finance & CFO
(501) 686-5671
Signed By Date
1/17/2024
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