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MEDI-SAVE PHARMACY
RRC040027-00 BAXTER REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BAXTER REGIONAL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC040027-00
Entity Address
624 HOSPITAL DRIVE
MOUNTAIN HOME, AR 72653
Medicare Provider Number
040027
Participating Start Date
1/1/2020
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
MEDI-SAVE PHARMACY
Pharmacy Address
116 HIGHWAY 201 NORTH
MOUNTAIN HOME, AR 72653
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Debbie Henry, CFO
(870) 508-1003
Contract Pharmacy Representative
Zibert Pharmaceutical Services, P.A. (DBA Medisave Pharmacy)
Leo Zibert, Owner
(870) 424-4010
Signed By Date
1/15/2018
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