Covered Entity Details

CAH041310-00 White River Health System, Inc. DBA Stone County Medical Center (Active) - information as of 5/13/2025 1:47:24 AM

Main Details

Name

White River Health System, Inc. DBA Stone County Medical Center

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041310-00

Medicare Provider Number

041310

Additional Details

Current Program Status

Active

Registration Date

8/17/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/11/2011

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

White River Health System
Shawna Jeffrey Ives, Controller
(870) 262-6100

Primary Contact

Stone County Medical Center
Amanda Langston, Pharmacist
(870) 262-5005 Ext: 5016

Addresses

Street Address

2106 East Main Street
Mountain View, AR 72560

Billing Address

Stone County Medical Center
PO Box 510
Mountain View, AR 72560

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ASHFLAT PHARMACY	JENNINGS DAVID T PROP	970 D ASHFLAT DRIVE PO BOX 278	ASH FLAT	AR	72513	04/15/2015	07/01/2015		04/15/2015
Contract Detail	BEST DRUG STORE OF NORTH CENTRAL ARKANSA	100 CASE COMMONS DRIVE	P.O. BOX 498	MOUNTAIN VIEW	AR	72560	04/03/2014	07/01/2014	05/15/2016	05/17/2016
Contract Detail	BRYANT'S INVESTMENTS & HOLDINGS, INC.	BRYANT'S PHARMACY & HEALTH CARE CENTER,	2000 HARRISON ST STE A SUITE A	BATESVILLE	AR	72501-7444	04/03/2014	07/01/2014	05/15/2016	05/17/2016
Contract Detail	CAVE CITY PHARMACY		301 S MAIN,SUITE C P O BOX 147	CAVE CITY	AR	72521	04/14/2015	07/01/2015		04/14/2015
Contract Detail	CORNER DRUG STORE	CORNER DRUG STORE	LISAGARDNER99@MAC.COM 830 EAST MAIN STREET	MELBOURNE	AR	72556-7255	04/14/2015	07/01/2015		04/14/2015
Contract Detail	DAVIS DRUGSTORE	DBA PILLBOX PHARMACY	1243 HIGHWAY 62 412 STE A	HARDY	AR	72542	04/14/2015	07/01/2015		04/14/2015
Contract Detail	ECONO-MART PHARMACY INC	1595 HARRISON ST		BATESVILLE	AR	72501	04/03/2014	07/01/2014	05/15/2016	05/17/2016
Contract Detail	ECONO-MED PHARMACY	1 CHOCTAW CTR		CHEROKEE VILLAGE	AR	72529-2701	04/14/2015	07/01/2015		04/14/2015
Contract Detail	HORSESHOE HEALTH AND MEDICINE	600 MARKET ST		HORSESHOE BEND	AR	72512	10/16/2015	01/01/2016		10/16/2015
Contract Detail	WAL-MART PHARMACY 10-1114	409 SYLAMORE AVENUE		MOUNTAIN VIEW	AR	72560	04/03/2014	07/01/2014		04/03/2014

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 3:36:03 PM	9/9/2024 1:35:02 PM	9/9/2024 1:35 PM
Contacts	Primary Contact	Update	Recertification	Langston, Amanda Pharmacist Stone County Medical Center 8702625005	Langston, Amanda Pharmacist Stone County Medical Center 8702625005-5016	8/22/2024 3:53 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 7:30:56 AM	9/6/2023 3:36:03 PM	9/6/2023 3:36 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 9:44:25 AM	9/13/2022 7:30:56 AM	9/13/2022 7:30 AM
Details	Last Recertification Date	Update	Recertification	8/24/2020 9:13:08 AM	8/19/2021 9:44:25 AM	8/19/2021 9:44 AM
Details	Last Recertification Date	Update	Recertification	8/29/2019 1:10:16 PM	8/24/2020 9:13:08 AM	8/24/2020 9:13 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 11:08:55 AM	8/29/2019 1:10:16 PM	8/29/2019 1:10 PM
Contacts	Authorizing Official	Update	Change Request	Richardson, Jana Controller White River Medical Center 8702623222	Ives, Shawna Jeffrey Controller White River Health System 8702626100	8/26/2019 8:45 AM
Details	Last Recertification Date	Update	Recertification	11/18/2017 12:09:10 PM	8/21/2018 11:08:55 AM	8/21/2018 11:08 AM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/18/2017 12:09:10 PM	11/18/2017 12:09 PM
Contacts	Primary Contact	Update	Recertification	Langston, Amanda Pharmacist 8702625005	Langston, Amanda Pharmacist Stone County Medical Center 8702625005	11/17/2017 4:30 PM
Contacts	Authorizing Official	Update		Richardson, Jana Controller 8702623222	Richardson, Jana Controller White River Medical Center 8702623222	11/16/2017 4:38 PM
Addresses	Main Address	Insert			2106 East Main Street Mountain View, AR 72560	5/1/2017 12:07 PM
Addresses	Billing Address	Insert			Stone County Medical Center PO Box 510 Mountain View, AR 72560	5/1/2017 12:07 PM
Contacts	Signed By	Insert			Britten, Gary CFO 8702621380	5/1/2017 12:07 PM
Contacts	Authorizing Official	Insert			Richardson, Jana Controller 8702623222	5/1/2017 12:07 PM
Contacts	Primary Contact	Insert			Langston, Amanda Pharmacist 8702625005	5/1/2017 12:07 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 11:39 AM
Details	Last Recertification Date	Update		8/29/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 7:18 AM
Details	Last Recertification Date	Update		9/4/2013 12:00:00 AM	8/29/2014 12:00:00 AM	8/29/2014 3:52 PM
Details	Last Recertification Date	Update		9/4/2013 12:48:51 PM	9/4/2013 12:00:00 AM	4/2/2014 7:38 AM
Details	Last Recertification Date	Update			9/4/2013 12:48:51 PM	9/4/2013 12:48 PM
Dates	Participating Approval Date	Update			9/11/2011 12:00:00 AM	9/11/2011 5:26 PM
Details	State	Update		Pending	Active	9/11/2011 5:26 PM
Details	Entity Name	Update		White River Health System, Inc.	White River Health System, Inc. DBA Stone County Medical Center	9/7/2011 9:54 AM
Details	Entity Subname	Update		Stone County Medical Center		9/7/2011 9:54 AM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/7/2011 9:54 AM
Details	340B ID	Update		CAH041310	CAH041310-00	8/22/2011 3:38 PM
Details	340B ID	Update		ONLINE_REG	CAH041310	8/22/2011 3:36 PM
Details	Last Recertification Date	Insert				8/17/2011 3:47 PM
Details	Grant Number	Insert				8/17/2011 3:47 PM
Details	340B ID	Insert			ONLINE_REG	8/17/2011 3:47 PM
Details	Is Authorizing Official EHB Data	Insert				8/17/2011 3:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/17/2011 3:47 PM
Details	Medicare Provider Number	Insert			041310	8/17/2011 3:47 PM
Details	Entity Name	Insert			White River Health System, Inc.	8/17/2011 3:47 PM
Details	Program Code	Insert			CAH	8/17/2011 3:47 PM
Details	Entity Subname	Insert			Stone County Medical Center	8/17/2011 3:47 PM
Dates	Participating Approval Date	Insert				8/17/2011 3:47 PM
Details	State	Insert			Pending	8/17/2011 3:47 PM
Dates	Registration Date	Insert			8/17/2011 12:00:00 AM	8/17/2011 3:47 PM
Dates	Signed By Date	Insert			8/17/2011 12:00:00 AM	8/17/2011 3:47 PM
Dates	Start Date	Insert				8/17/2011 3:47 PM
Terminations	Termination Comments	Insert				8/17/2011 3:47 PM
Terminations	Termination Date	Insert				8/17/2011 3:47 PM
Terminations	Termination Effective Date	Insert				8/17/2011 3:47 PM
Terminations	Termination Reason	Insert				8/17/2011 3:47 PM