Contract Pharmacy Details

FRED'S PHARMACY #3341
DSH040071 JEFFERSON REGIONAL MEDICAL CENTER

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

FRED'S PHARMACY #3341

Pharmacy Address

8515 DOLLARWAY RD
WHITE HALL, AR 71602-2812

Pharmacy Comments

Contract Details

Approval Date

4/22/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

BRYAN JACKSON, CHIEF ADMINISTRATIVE OFFICER
(870) 541-7141

Contract Pharmacy Representative

Shannon Strickland, SVP, Pharmacy Development
(901) 238-3113

Signed By Date

4/22/2015

340B Drug Pricing Program Database