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STEPHEN L. LAFRANCE PHARMACY, INC.
DSH040016 UNIVERSITY OF ARKANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ARKANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040016
Entity Address
4301 WEST MARKHAM ST
Slot 571
LITTLE ROCK, AR 72205
Medicare Provider Number
040016
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
STEPHEN L. LAFRANCE PHARMACY, INC.
Pharmacy Address
DBA: WALGREENS #15830
1401 E HARDING AVENUE
PINE BLUFF, AR 71601
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
11/21/2013
Carve-In Effective Date
Contract Comments
04/11/2014 Contract pharmacy restored with begin date adjustment due to ownership change
Contract Termination Date
Termination Reason
6/27/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
MELISSA FONTAINE, Chief Operating Officer
(501) 686-8955
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2013
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