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SMITH FAMILY PHARMACY
DSH040029 CONWAY REGIONAL MEDICAL CENTER INC
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Covered Entity Details
Entity Name
CONWAY REGIONAL MEDICAL CENTER INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040029
Entity Address
2302 COLLEGE AVENUE
CONWAY, AR 72034
Medicare Provider Number
040029
Participating Start Date
10/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SMITH FAMILY PHARMACY
Pharmacy Address
2425 DAVE WARD DR STE 602
CONWAY, AR 72034-8685
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Reed, VP of Clinical Support Services/CIO
(501) 513-5152
Contract Pharmacy Representative
Smith Family Pharmacy
Robert Blake Johnson, Owner
(501) 336-8188
Signed By Date
1/15/2025
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