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FRED'S PHARMACY
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
FRED'S PHARMACY
Pharmacy Address
3395 HIGHWAY 5 NORTH
BENTON, AR 72015
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/29/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Stephen Mette, Chief Clinical Officer
(501) 686-8111
Contract Pharmacy Representative
Tim Liebmann, EVP & COO Pharmacy
(901) 238-2634
Signed By Date
1/17/2017
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