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KROGER PHARMACY #606
DSH040076 Baptist Health Medical Center - Hot Spring County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Hot Spring County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040076
Entity Address
1001 SCHNEIDER DRIVE
MALVERN, AR 72104
Medicare Provider Number
040076
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
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
1/1/2018
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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