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CORNERSTONE PHARMACY OTTER CREEK, LLC
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
CORNERSTONE PHARMACY OTTER CREEK, LLC
Pharmacy Address
10320 STAGECOACH RD
(INSIDE EDWARDS FOOD GIANT)
LITTLE ROCK, AR 72210-4750
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Layton Kelley, Assistant Director UAMS OPC Pharmacy
(501) 686-5050
Contract Pharmacy Representative
Cornerstone Pharmacy Otter Creek
Eric Shelley, PIC
(501) 455-1900
Signed By Date
7/12/2024
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