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FRED'S PHARMACY
CAH041312-00 BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS
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Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER HEBER SPRINGS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041312-00
Entity Address
1800 BYPASS ROAD
HEBER SPRINGS, AR 72543
Medicare Provider Number
041312
Participating Start Date
9/27/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY
Pharmacy Address
308 S 7TH ST
HEBER SPRINGS, AR 72543-3719
Pharmacy Comments
Contract Details
Approval Date
10/4/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/8/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
10/4/2016
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