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KROGER PHARMACY #606
DSH040072 BAPTIST HEALTH MEDICAL CENTER - STUTTGART
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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 #606
Pharmacy Address
110 COMMONS DR.
MAUMELLE, AR 72113
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/18/2017
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