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WILSON BEARDEN PHARMACY
SCH040067-00 MAGNOLIA REGIONAL HEALTH SYSTEM INC
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Covered Entity Details
Entity Name
MAGNOLIA REGIONAL HEALTH SYSTEM INC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH040067-00
Entity Address
101 Hospital Drive
MAGNOLIA, AR 71753
Medicare Provider Number
040067
Participating Start Date
7/1/2024
Last Recertification Date
9/9/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WILSON BEARDEN PHARMACY
Pharmacy Address
134 N. WASHINGTON
MAGNOLIA, AR 71753
Pharmacy Comments
Contract Details
Approval Date
4/23/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brett Kinman, CEO
(870) 235-3212
Contract Pharmacy Representative
Wilson Bearden
Ivy Moore, Owner
(870) 234-1062
Signed By Date
4/12/2024
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