Contract Pharmacy Details

FRED'S PHARMACY #2916
DSH040014 WHITE COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

WHITE COUNTY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH040014

Entity Address

3214 East Race Avenue
SEARCY, AR 72143

Medicare Provider Number

040014

Participating Start Date

4/1/2015

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

FRED'S PHARMACY #2916

Pharmacy Address

2706 EAST RACE AVENUE
SEARCY, AR 72143

Pharmacy Comments

Contract Details

Approval Date

10/12/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/12/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

STUART HILL, VP/CFO
(501) 380-1004

Contract Pharmacy Representative

Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346

Signed By Date

10/12/2016

340B Drug Pricing Program Database