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MCCOY & TYGART DRUG STORE INC
DSH040071 JEFFERSON REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JEFFERSON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040071
Entity Address
1600 WEST 40TH AVENUE
PINE BLUFF, AR 71603
Medicare Provider Number
040071
Participating Start Date
4/1/2000
Last Recertification Date
9/6/2024
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
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeremy Jeffery, Senior Vice President & Chief Financial Officer
(870) 541-5945
Contract Pharmacy Representative
Mccoy-Tygart Drug
Casey Hedden, Pharmacist in Charge
(870) 942-5121
Signed By Date
10/7/2024
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