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FRED'S PHARMACY #1908
CAH041323-00 ASHLEY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ASHLEY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041323-00
Entity Address
1015 UNITY ROAD
CROSSETT, AR 71635
Medicare Provider Number
041323
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY #1908
Pharmacy Address
700 N MAIN ST
HAMBURG, AR 71646-2718
Pharmacy Comments
Contract Details
Approval Date
4/18/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
PHILLIP GILMORE, CHIEF EXECUTIVE OFFICER
(870) 364-4111 Ext: 271
Contract Pharmacy Representative
Fred's Pharmacy
Nicole Pearson, 340B Program Manager
(901) 500-6153
Signed By Date
4/18/2017
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