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THE PHARMACY AT FLIPPIN STATION
RRC040027-00 BAXTER REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BAXTER REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040027-00
Entity Address
624 HOSPITAL DRIVE
MOUNTAIN HOME, AR 72653
Medicare Provider Number
040027
Participating Start Date
1/1/2020
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
THE PHARMACY AT FLIPPIN STATION
Pharmacy Address
109 N 1ST ST
FLIPPIN, AR 72634
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Ryan Killian, Director of Pharmacy
(870) 508-1377
Contract Pharmacy Representative
Caeverett, Inc.
Lisa Gardner, Owner
(870) 368-7171
Signed By Date
4/15/2024
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