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AZINA, LLC
DSH040051 Baptist Health Medical Center - Drew County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Drew County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040051
Entity Address
778 SCOGIN DRIVE
MONTICELLO, AR 71655
Medicare Provider Number
040051
Participating Start Date
7/1/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
AZINA, LLC
Pharmacy Address
5515 PARKCENTER CIR
SUITE 175
DUBLIN, OH 43017
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Comprehensive Pharmacy Services
Doug Massey, EVP, Specialty and Ambulatory Operations
(800) 968-6962
Signed By Date
1/17/2024
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