Covered Entity Details

DSH040014 WHITE COUNTY MEDICAL CENTER (Active) - information as of 4/30/2025 10:52:49 PM

Main Details

Name

WHITE COUNTY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH040014

Medicare Provider Number

040014

Additional Details

Current Program Status

Active

Registration Date

5/23/2007

Participating Start Date

4/1/2015

Participating Approval Date

5/23/2007

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

White County Medical Center
Stuart Randall Hill, VP Treasurer
(501) 380-1004

Primary Contact

White County Medical Center
Scotty Terl Parker, AVP Ancillary Services
(501) 380-1382

Addresses

Street Address

3214 East Race Avenue
SEARCY, AR 72143

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/12/15 participating 7/1/07 thru 12/31/13 as DSH hospital, 340B ID terminated when hospital converted to SCH entity type effective 1/1/14, changed entity type back to DSH effective 4/1/15 based on on-line registration submitted in January 2015; 3/24/2010- DOCUMENT RECD. TO CONFIRM ELIGIBLE OWNERSHIP TYPE; 12/13/08 OPA NOTIFIED ON 11/25/08 DOC RECD TO CONFIRM ELIG DSH ADJ%	03/12/2015
3/24/2010- DOCUMENT RECD. TO CONFIRM ELIGIBLE OWNERSHIP TYPE; 12/13/08 OPA NOTIFIED ON 11/25/08 DOC RECD TO CONFIRM ELIG DSH ADJ%	05/18/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
AR	129186105	1568406536

Shipping Addresses

Shipping Address 1

WHITE COUNTY MEDICAL CENTER
3214 East Race Avenue
Searcy, AR 72143

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALLCARE PHARMACY	10620 COLONEL GLENN RD	STE. 400	LITTLE ROCK	AR	72204	04/18/2017	07/01/2017	10/18/2017	10/18/2017
Contract Detail	ALLCARE SPECIALTY PHARMACY, LLC	10620 COLONEL GLENN RD STE 300		LITTLE ROCK	AR	72204-8048	10/18/2017	10/18/2017		10/18/2017
Contract Detail	ARCARE	DBA ARCARE PHARMACY 05	304 HIGHWAY 64 E	AUGUSTA	AR	72006-5131	07/19/2019	10/01/2019		10/01/2019
Contract Detail	ARCARE	DBA ARCARE PHARMACY 15	821 E PARK ST PO BOX 24	CARLISLE	AR	72024-9024	07/19/2019	10/01/2019	03/31/2024	04/10/2024
Contract Detail	ARCARE PHARMACY 12	615 N MAIN ST		BRINKLEY	AR	72021-2507	07/19/2019	10/01/2019	03/31/2024	04/10/2024
Contract Detail	ARCARE PHARMACY 13	5787 HIGHWAY 64		PARKIN	AR	72373-9003	07/19/2019	10/01/2019	03/31/2024	04/10/2024
Contract Detail	ARCARE PHARMACY 84	105 N. JACKSON ST.		CABOT	AR	72023-3309	07/19/2019	10/01/2019		10/01/2019
Contract Detail	BEEBE DRUG INC	703 W DEWITT HENRY DR		BEEBE	AR	72012-2101	10/15/2020	01/01/2021		01/01/2021
Contract Detail	BURROWS REXALL DRUG COMPANY	45 HIGHWAY 64 W	P O BOX 248	BEEBE	AR	72012	10/15/2020	01/01/2021	10/23/2023	12/21/2023
Contract Detail	DARLING MEDI-SAVE	JIM DARLING	1303 MCLAIN ST	NEWPORT	AR	72112-7211	10/07/2016	01/01/2017		05/03/2017
Contract Detail	FRED'S PHARMACY	901 DEWITT HENRY BLVD.		BEEBE	AR	72012	10/12/2016	01/01/2017	11/06/2019	11/11/2019
Contract Detail	FRED'S PHARMACY	308 S 7TH ST		HEBER SPRINGS	AR	72543-3719	10/12/2016	01/01/2017	11/06/2019	11/11/2019
Contract Detail	FRED'S PHARMACY #1096	170 HWY 167		BALD KNOB	AR	72010	10/12/2016	01/01/2017	11/06/2019	11/11/2019
Contract Detail	FRED'S PHARMACY #1216	207 S 2ND ST		CABOT	AR	72023-2919	10/12/2016	01/01/2017	11/12/2018	12/26/2018
Contract Detail	FRED'S PHARMACY #2916	2706 EAST RACE AVENUE		SEARCY	AR	72143	10/12/2016	01/01/2017	11/12/2018	12/26/2018
Contract Detail	HARP'S PHARMACY #114	801 N 2ND ST		CABOT	AR	72023-2547	01/07/2016	04/01/2016		05/03/2017
Contract Detail	HARPS PHARMACY #136	2525 W BEEBE CAPPS EXPY		SEARCY	AR	72143-4909	04/02/2015	07/01/2015		05/03/2017
Contract Detail	HARPS PHARMACY #163	901 W MAIN ST		HEBER SPRINGS	AR	72543	01/07/2016	04/01/2016		05/03/2017
Contract Detail	ICARERX PHARMACY	ICARERX PHARMACY	1117 MCLAIN ST STE 400	NEWPORT	AR	72112-3545	07/12/2018	10/01/2018		10/01/2018
Contract Detail	INFINITY COMPOUNDING SOLUTIONS, LLC	DBA INFINITY CARE SOLUTIONS	1204 SE 28TH ST STE 2	BENTONVILLE	AR	72712-3887	07/19/2019	10/01/2019		10/01/2019
Contract Detail	JOE'S PHARMACY EXPRESS	2412 E RACE AVE STE F		SEARCY	AR	72143-4780	03/26/2015	04/01/2015	04/30/2017	05/03/2017
Contract Detail	JOE'S PHARMACY EXPRESS	2412 E RACE AVE STE F		SEARCY	AR	72143-4780	01/09/2019	04/01/2019	03/20/2025	04/09/2025
Contract Detail	JOE'S PHARMACY EXPRESS	2412 E RACE AVE STE F		SEARCY	AR	72143	03/21/2025	03/21/2025		03/24/2025
Contract Detail	PALACE DRUG	313 MAIN ST		DES ARC	AR	72040	04/10/2024	07/01/2024		07/01/2024
Contract Detail	PHARM Z LLC	BURROW'S DRUG STORE	45 HWY 64 W	BEEBE	AR	72012	12/21/2023	12/21/2023		12/22/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/10/2017	10/01/2017	10/31/2022	10/31/2022
Contract Detail	SEARCY MEDICAL CENTER PHARMACY LLP	2900 HAWKINS DR.		SEARCY	AR	72143-7214	03/26/2015	04/01/2015	01/31/2024	06/24/2024
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/05/2024	04/01/2024	10/01/2024	10/08/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/05/2024	04/01/2024		04/01/2024
Contract Detail	STANLEY AND TURNER DRUG COMPANY	DBA STANLEY PHARMACY COMPOUNDING CENTER	2413 W BEEBE CAPPS EXPY	SEARCY	AR	72143	01/09/2019	04/01/2019		04/01/2019
Contract Detail	STANLEY PHARMACY	2007 W BEEBE CAPPS EXPY	STAN-KEL PHARMACIES, INC	SEARCY	AR	72143-5014	01/09/2019	04/01/2019		04/01/2019
Contract Detail	STEPHEN L. LA FRANCE PHARMACY, INC.	DBA: WALGREENS #15819	1540 E RACE AVENUE	SEARCY	AR	72143	03/26/2015	04/01/2015	07/12/2018	07/12/2018
Contract Detail	STOTTS DRUG STORE INC	103 W ARCH AVE		SEARCY	AR	72143	03/26/2015	04/01/2015	03/31/2024	04/10/2024
Contract Detail	STOTTS FAMILY PHARMACY	103 W. ARCH AVE		SEARCY	AR	72143	04/10/2024	07/01/2024		07/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/13/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-0018	1211 HIGHWAY 367 N		NEWPORT	AR	72112	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-0119	3150 HARRISON ST		BATESVILLE	AR	72501	04/15/2016	07/01/2016		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-0157	3509 EAST RACE AVENUE		SEARCY	AR	72143	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-0281	1500 HIGHWAY 25B NORTH		HEBER SPRINGS	AR	72543	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-2431	1330 WEST BEEBE CAPPS EXPRESSWAY		SEARCY	AR	72143	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-2587	304 SOUTH ROCKWOOD		CABOT	AR	72023	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-4168	2003 WEST CENTER ST.		BEEBE	AR	72012	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/10/2024	07/01/2024		07/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/13/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10059	1325 W MAIN ST	CABOT	AR	72023-2458	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #11161	2401 MALCOLM AVE	NEWPORT	AR	72112	03/26/2015	04/01/2015		05/03/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09766	200 E RACE AVE	SEARCY	AR	72143	03/26/2015	04/01/2015		05/03/2017
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/14/2022	07/01/2022		07/01/2022
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	03/26/2015	04/01/2015	06/17/2015	05/03/2017
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	03/26/2015	04/01/2015	06/17/2015	05/03/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/14/2015	10/01/2015		05/03/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/14/2015	10/01/2015	10/31/2022	10/31/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/14/2015	10/01/2015		05/03/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/14/2015	10/01/2015		05/03/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH040014AA	Child	DSH	WHITE COUNTY MEDICAL CENTER	UH Medical Clinic Heber Springs	2725 AR-25 Bypass	Heber Springs	AR	Active
DSH040014AB	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Operating Room	1205 McLain Street	Newport	AR	Terminated
DSH040014AC	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Anesthesiology	1205 McLain Street	Newport	AR	Terminated
DSH040014AD	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Radiology	1205 McLain Street	Newport	AR	Terminated
DSH040014AE	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Lab	1205 McLain Street	Newport	AR	Terminated
DSH040014AF	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Respiratory Therapy	1205 McLain Street	Newport	AR	Terminated
DSH040014AG	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Physical Therapy	1205 McLain Street	Newport	AR	Terminated
DSH040014AH	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Emergency Room	1205 McLain Street	Newport	AR	Terminated
DSH040014AJ	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Center / Acute Care Hospital - Adults and Peds	1205 McLain Street	Newport	AR	Terminated
DSH040014AK	Child	DSH	WHITE COUNTY MEDICAL CENTER	Searcy Medical Center - West / Gen Medicine	2505 West Beebe Capps Expressway, Suite 100	Searcy	AR	Active
DSH040014AL	Child	DSH	WHITE COUNTY MEDICAL CENTER	Searcy Medical Center - West Pediatric Clinic / Pediatrics	2505 West Beebe Capps Expy	Searcy	AR	Active
DSH040014AM	Child	DSH	WHITE COUNTY MEDICAL CENTER	UNITY HEALTH BRADFORD MEDICAL CLINIC	504 W MAIN St - Suite A	BRADFORD	AR	Active
DSH040014AN	Child	DSH	WHITE COUNTY MEDICAL CENTER	Rheumatology - Rheumatology	2902 East Race Avenue	Searcy	AR	Active
DSH040014AP	Child	DSH	WHITE COUNTY MEDICAL CENTER	UNITY HEALTH NEWPORT PEDIATRICS CLI - UH Newport Pediatrics Clinic	1200 MCLAIN ST	NEWPORT	AR	Terminated
DSH040014AQ	Child	DSH	WHITE COUNTY MEDICAL CENTER	Unity Health - Neurology - Neurology	2902 East Race Avenue	Searcy	AR	Approved
DSH040014AR	Child	DSH	WHITE COUNTY MEDICAL CENTER	Surgery Center - White County Surgery Center	710 Marion Street - Suite 101	Searcy	AR	Approved
DSH040014AS	Child	DSH	WHITE COUNTY MEDICAL CENTER	Radiology - Unity Health Radiology West	2505 West Beebe Capps Expressway	Searcy	AR	Approved
DSH040014B	Child	DSH	WHITE COUNTY MEDICAL CENTER	WHITE COUNTY ONCOLOGY	415 Rodgers Drive Suite A	SEARCY	AR	Active
DSH040014E	Child	DSH	WHITE COUNTY MEDICAL CENTER	FAMILY PRACTICE ASSOCIATES / Family Medicine	3130 E RACE AVE 100	Searcy	AR	Active
DSH040014F	Child	DSH	WHITE COUNTY MEDICAL CENTER	Westside Family Med Clinic / Family Medicine	103 WOODLANE DR	SEARCY	AR	Terminated
DSH040014G	Child	DSH	WHITE COUNTY MEDICAL CENTER	Cardiology Clinic	711 SANTA FE DR	SEARCY	AR	Active
DSH040014H	Child	DSH	WHITE COUNTY MEDICAL CENTER	ORTHOPEDIC & SPINE CENTER PHYSICAL / Multispeciality	710 MARION ST	SEARCY	AR	Active
DSH040014J	Child	DSH	WHITE COUNTY MEDICAL CENTER	SEARCY MEDICAL CENTER / Multispeciality (Family Med, Internal Med, Ortho etc.)	2900 HAWKINS DR	SEARCY	AR	Active
DSH040014K	Child	DSH	WHITE COUNTY MEDICAL CENTER	MCAFEE MEDICAL CLINIC	710-A West Dewitt Henry Drive	BEEBE	AR	Active
DSH040014L	Child	DSH	WHITE COUNTY MEDICAL CENTER	McAfee Urgent Care	2900 Hawkins Drive	Searcy	AR	Terminated
DSH040014M	Child	DSH	WHITE COUNTY MEDICAL CENTER	CLARITY HEALTH AND WELLNESS	2908 HAWKINS DR	SEARCY	AR	Active
DSH040014N	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Medical Clinic	1200 McLain Street, Suite B	Newport	AR	Terminated
DSH040014P	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Family Practice Clinic	1200 McLain Street	Newport	AR	Terminated
DSH040014Q	Child	DSH	WHITE COUNTY MEDICAL CENTER	UH Green Family Practice Clinic	1200 McLain Street. Suite G	Newport	AR	Active
DSH040014R	Child	DSH	WHITE COUNTY MEDICAL CENTER	UH Newport OB/GYN Clinic	1201 McLain Street	Newport	AR	Active
DSH040014S	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Podiatry Clinic	1117 McLain Street, Suite 500	Newport	AR	Terminated
DSH040014T	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Orthopedic Clinic	1117 McLain Street	Newport	AR	Terminated
DSH040014U	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Surgical Clinic	1117 McLain Street, Suite 300	Newport	AR	Terminated
DSH040014V	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Pediatric Clinic	2000 McLain Street, Suite B	Newport	AR	Terminated
DSH040014W	Child	DSH	WHITE COUNTY MEDICAL CENTER	Harris Internal Med Clinic	2000 McLain Street	Newport	AR	Terminated
DSH040014X	Child	DSH	WHITE COUNTY MEDICAL CENTER	UH Newport Family Practice	1200 McLain Street, Suite B & D	Newport	AR	Active
DSH040014Y	Child	DSH	WHITE COUNTY MEDICAL CENTER	Newport Cardiology Clinic	2000 McLain Street	Newport	AR	Terminated
DSH040014Z	Child	DSH	WHITE COUNTY MEDICAL CENTER	Newport Pediatric Clinic	2000 McLain Street	Newport	AR	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		WHITE COUNTY MEDICAL CENTER 3214 East Race Avenue Searcy, AR 72143	10/9/2024 7:16 AM
Addresses	Main Address	Update	Change Request	3214 East Race SEARCY, AR 72143	3214 East Race Avenue SEARCY, AR 72143	10/9/2024 7:16 AM
Addresses	Shipping Address	Delete	Change Request	White County Medical Center, DBA:Unity Health-Harris Medical Center 1205 McLain Street Newport, AR 72112		10/8/2024 11:40 AM
Details	Last Recertification Date	Update	Recertification	9/11/2023 1:07:50 PM	9/6/2024 1:50:00 PM	9/6/2024 1:50 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 4:05:06 PM	9/11/2023 1:07:50 PM	9/11/2023 1:07 PM
Details	Last Recertification Date	Update	Recertification	9/13/2021 1:06:03 PM	9/15/2022 4:05:06 PM	9/15/2022 4:05 PM
Addresses	Main Address	Update	Change Request	3214 E Race SEARCY, AR 72143	3214 East Race SEARCY, AR 72143	4/18/2022 8:07 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 2:08:44 PM	9/13/2021 1:06:03 PM	9/13/2021 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568406536	9/14/2020 2:08 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/14/2020 2:08 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1568406536 ( )		9/14/2020 2:08 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 7:55:33 AM	9/14/2020 2:08:44 PM	9/14/2020 2:08 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 8:00:04 AM	9/10/2019 7:55:33 AM	9/10/2019 7:55 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 3:23:09 PM	8/22/2018 8:00:04 AM	8/22/2018 8:00 AM
Contacts	Authorizing Official	Insert	Change Request		Hill, Stuart Randall VP Treasurer White County Medical Center 5013801004	11/22/2017 7:49 AM
Contacts	Primary Contact	Insert	Recertification		Parker, Scotty Terl AVP Ancillary Services White County Medical Center 5013801382	11/6/2017 3:23 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/6/2017 3:23:09 PM	11/6/2017 3:23 PM
Addresses	Main Address	Insert			3214 E Race SEARCY, AR 72143	5/3/2017 11:48 AM
Addresses	Shipping Address	Insert			White County Medical Center, DBA:Unity Health-Harris Medical Center 1205 McLain Street Newport, AR 72112	5/3/2017 11:48 AM
Medicaid Billing	NPI: Number	Insert			1568406536	9/1/2016 4:57 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 4:57 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/10/2015 5:47 PM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 5:47 PM
Terminations	Termination Comments	Update		Conversion to SCH entity type		3/23/2015 2:43 PM
Details	Last Recertification Date	Update		9/3/2013 12:00:00 AM		3/12/2015 5:11 PM
Dates	Last Date That 340B Drugs Purchased	Update		1/1/2014 12:00:00 AM		3/12/2015 5:11 PM
Details	State	Update		Terminated	Active	3/12/2015 5:11 PM
Dates	Start Date	Update		7/1/2007 12:00:00 AM	4/1/2015 12:00:00 AM	3/12/2015 5:11 PM
Terminations	Termination Date	Update		1/1/2014 12:00:00 AM		3/12/2015 5:11 PM
Terminations	Termination Effective Date	Update		1/1/2014 12:00:00 AM		3/12/2015 5:11 PM
Terminations	Termination Reason	Update		Change of covered entity type		3/12/2015 5:11 PM
Details	Comments Public	Insert			3/12/15 participating 7/1/07 thru 12/31/13 as DSH hospital, 340B ID terminated when hospital converted to SCH entity type effective 1/1/14, changed entity type back to DSH effective 4/1/15 based on on-line registration submitted in January 2015; 3/24/2010- DOCUMENT RECD. TO CONFIRM ELIGIBLE OWNERSHIP TYPE; 12/13/08 OPA NOTIFIED ON 11/25/08 DOC RECD TO CONFIRM ELIG DSH ADJ%	3/12/2015 5:11 PM
Dates	Last Date That 340B Drugs Purchased	Update			1/1/2014 12:00:00 AM	11/8/2013 11:53 AM
Details	State	Update		Active	Terminated	11/8/2013 11:53 AM
Terminations	Termination Comments	Update			Conversion to SCH entity type	11/8/2013 11:53 AM
Terminations	Termination Date	Update			1/1/2014 12:00:00 AM	11/8/2013 11:53 AM
Terminations	Termination Effective Date	Update			1/1/2014 12:00:00 AM	11/8/2013 11:53 AM
Terminations	Termination Reason	Update			Change of covered entity type	11/8/2013 11:53 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/3/2013 12:00:00 AM	9/3/2013 12:50 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 3:45 PM
Details	Last Recertification Date	Insert				5/18/2010 9:06 AM
Details	Grant Number	Insert				5/18/2010 9:06 AM
Details	340B ID	Insert			DSH040014	5/18/2010 9:06 AM
Details	Is Authorizing Official EHB Data	Insert				5/18/2010 9:06 AM
Dates	Last Date That 340B Drugs Purchased	Insert				5/18/2010 9:06 AM
Details	Medicare Provider Number	Insert			040014	5/18/2010 9:06 AM
Details	Entity Name	Insert			WHITE COUNTY MEDICAL CENTER	5/18/2010 9:06 AM
Details	Program Code	Insert			DSH	5/18/2010 9:06 AM
Details	Entity Subname	Insert				5/18/2010 9:06 AM
Dates	Participating Approval Date	Insert			5/23/2007 12:00:00 AM	5/18/2010 9:06 AM
Details	State	Insert			Active	5/18/2010 9:06 AM
Dates	Registration Date	Insert			5/23/2007 12:00:00 AM	5/18/2010 9:06 AM
Dates	Signed By Date	Insert			5/1/2007 12:00:00 AM	5/18/2010 9:06 AM
Dates	Start Date	Insert			7/1/2007 12:00:00 AM	5/18/2010 9:06 AM
Terminations	Termination Comments	Insert				5/18/2010 9:06 AM
Terminations	Termination Date	Insert				5/18/2010 9:06 AM
Terminations	Termination Effective Date	Insert				5/18/2010 9:06 AM
Terminations	Termination Reason	Insert				5/18/2010 9:06 AM
Details	Comments Public	Insert			3/24/2010- DOCUMENT RECD. TO CONFIRM ELIGIBLE OWNERSHIP TYPE; 12/13/08 OPA NOTIFIED ON 11/25/08 DOC RECD TO CONFIRM ELIG DSH ADJ%	5/18/2010 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	5/23/2007 11:17 AM
Medicaid Billing	Medicaid: Number	Insert			129186105	5/23/2007 11:17 AM
Medicaid Billing	Medicaid: State	Insert			AR	5/23/2007 11:17 AM