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PHARM-MART PHARMACY OF WARREN INC.
DSH040051 Baptist Health Medical Center - Drew County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Drew County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040051
Entity Address
778 SCOGIN DRIVE
MONTICELLO, AR 71655
Medicare Provider Number
040051
Participating Start Date
7/1/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
PHARM-MART PHARMACY OF WARREN INC.
Pharmacy Address
DBA: WALGREENS #15817
310 SOUTH MARTIN
WARREN, AR 71671
Pharmacy Comments
Contract Details
Approval Date
4/20/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Barrilleaux, CEO
(870) 460-3589
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/20/2015
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