Contract Pharmacy Details

KROGER PHARMACY #576
DSH040072 BAPTIST HEALTH MEDICAL CENTER - STUTTGART

Covered Entity Details

Entity Name

BAPTIST HEALTH MEDICAL CENTER - STUTTGART

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH040072

Entity Address

1703 NORTH BUERKLE
STUTTGART, AR 72160

Medicare Provider Number

040072

Participating Start Date

1/1/2011

Last Recertification Date

9/18/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #576

Pharmacy Address

301 PINE BLUFF HIGHWAY
ENGLAND, AR 72046

Pharmacy Comments

Contract Details

Approval Date

10/20/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/15/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Harrison Dean, Senior VP of Regional Hospitals
(501) 202-3801

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

10/20/2015

340B Drug Pricing Program Database