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PPG STORE 6, LLC
DSH040029 CONWAY REGIONAL MEDICAL CENTER INC
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Covered Entity Details
Entity Name
CONWAY REGIONAL MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040029
Entity Address
2302 COLLEGE AVENUE
CONWAY, AR 72034
Medicare Provider Number
040029
Participating Start Date
10/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PPG STORE 6, LLC
Pharmacy Address
DBA: HEARTLAND PHARMACY CONWAY
2235 DAVE WARD DR STE 108
DBA HEARTLAND PHARMACY CONWAY
CONWAY, AR 72034-7040
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Reed, VP of Clinical Support Services/CIO
(501) 513-5152
Contract Pharmacy Representative
Heartland Pharmacy
Clint S Boone, Pharmacist Co-owner
(501) 904-4299
Signed By Date
7/11/2024
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