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KROGER PHARMACY #642
DSH040036 BAPTIST HEALTH MEDICAL CENTER- NLR
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER- NLR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040036
Entity Address
3333 SPRINGHILL DRIVE
NORTH LITTLE ROCK, AR 72117
Medicare Provider Number
040036
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #642
Pharmacy Address
6929 J F K BOULEVARD
NORTH LITTLE ROCK, AR 72116
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
10/15/2024
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