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MCCOY & TYGART DRUG STORE INC
DSH040114 BAPTIST HEALTH MEDICAL CENTER - LR
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - LR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040114
Entity Address
9601 Baptist Health Drive
LITTLE ROCK, AR 72205
Medicare Provider Number
040114
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
MCCOY & TYGART DRUG STORE INC
Pharmacy Address
821 N ROCK ST
P.O. BOX 217
SHERIDAN, AR 72150-7623
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
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Mccoy-Tygart Drug
Casey Hedden, Pharmacist in Charge
(870) 942-5121
Signed By Date
7/11/2024
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