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WEST SIDE PHARMACY INCORPORATED
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
WEST SIDE PHARMACY INCORPORATED
Pharmacy Address
WEST SIDE PHARMACY INCORPORATED
620 W SOUTH ST STE C
BENTON, AR 72015-4235
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
St. Francis Discount Pharmacy LLC
Blake Torres, Owner
(501) 317-5914
Signed By Date
7/12/2024
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