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DALTON HERZIG, INC.
STD72114 Pinnacle Health Partners, PLLC
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Covered Entity Details
Entity Name
Pinnacle Health Partners, PLLC
Subdivision Name
Diversity Family Health
Type
Sexually Transmitted Diseases
340B ID
STD72114
Entity Address
500 South University
Suite 711
AR
Little Rock, AR 72205
Grant Number
NH25PS0051320508
Participating Start Date
10/1/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
DALTON HERZIG, INC.
Pharmacy Address
DBA PARK WEST PHARMACY
904 AUTUMN RD STE 275
LITTLE ROCK, AR 72211-3745
Pharmacy Comments
Contract Details
Approval Date
4/2/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Park West Rx
Gwen Herzig, President
(501) 224-3499
Signed By Date
4/2/2024
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