Details | Last Recertification Date | Update | Recertification | 2/1/2024 10:14:40 AM | 2/11/2025 2:33:38 PM | 2/11/2025 2:33 PM |
Details | Last Recertification Date | Update | Recertification | 2/3/2023 11:50:25 AM | 2/1/2024 10:14:40 AM | 2/1/2024 10:14 AM |
Details | Last Recertification Date | Update | Recertification | 1/31/2022 11:38:22 AM | 2/3/2023 11:50:25 AM | 2/3/2023 11:50 AM |
Details | Last Recertification Date | Update | Recertification | 2/2/2021 5:40:24 PM | 1/31/2022 11:38:22 AM | 1/31/2022 11:38 AM |
Details | Last Recertification Date | Update | Recertification | 1/28/2020 10:07:21 AM | 2/2/2021 5:40:24 PM | 2/2/2021 5:40 PM |
Contacts | Primary Contact | Update | Change Request | Hamilton, Marcy
Controller
River Valley Primary Care Services, Inc.
4794312057 | Yates, Claire Elizabeth
340B Coordinator
RVPCS
4794312050-9034 | 9/22/2020 6:35 AM |
Contacts | Primary Contact | Update | Change Request | Yates, Claire Elizabeth
340B Coordinator
RVPCS
4794312050-956 | Hamilton, Marcy
Controller
River Valley Primary Care Services, Inc.
4794312057 | 4/22/2020 6:33 PM |
Details | Last Recertification Date | Update | Recertification | 1/30/2019 9:30:46 AM | 1/28/2020 10:07:21 AM | 1/28/2020 10:07 AM |
Contacts | Authorizing Official | Update | Profile Change Request | WHITE, JERRY
CEO
River Valley primary Care Services
4796350091-240 | WHITE, JERRY
CEO
River Valley primary Care Services
4794312057-9040 | 9/6/2019 10:40 AM |
Contacts | Signed By | Update | Profile Change Request | WHITE, JERRY
CEO
River Valley primary Care Services
4796350091-240 | WHITE, JERRY
CEO
River Valley primary Care Services
4794312057-9040 | 9/6/2019 10:40 AM |
Details | Last Recertification Date | Update | Recertification | | 1/30/2019 9:30:46 AM | 1/30/2019 9:30 AM |
Contacts | Primary Contact | Update | Profile Change Request | Yates, Claire Elizabeth
340B Coordinator
RVPCS
4796350091-259 | Yates, Claire Elizabeth
340B Coordinator
RVPCS
4794312050-956 | 1/9/2019 5:05 PM |
Details | State | Update | | Approved | Active | 1/1/2019 12:05 AM |
Contacts | Primary Contact | Update | Change Request | McKinney, Nikki
HR/Administrative Manager
RVPCS
4796350091-239 | Yates, Claire Elizabeth
340B Coordinator
RVPCS
4796350091-259 | 12/14/2018 10:06 AM |
Contacts | Signed By | Insert | New Registration | | WHITE, JERRY
CEO
River Valley primary Care Services
4796350091-240 | 10/3/2018 2:06 PM |
Details | 340B ID | Update | New Registration | | CH061202H | 10/3/2018 2:06 PM |
Dates | Participating Approval Date | Update | New Registration | | 10/3/2018 2:06:18 PM | 10/3/2018 2:06 PM |
Details | State | Update | New Registration | Pending | Approved | 10/3/2018 2:06 PM |
Dates | Signed By Date | Update | New Registration | | 10/3/2018 9:34:12 AM | 10/3/2018 2:06 PM |
Dates | Start Date | Update | New Registration | | 1/1/2019 12:00:00 AM | 10/3/2018 2:06 PM |
Addresses | Main Address | Insert | New Registration | |
2074 Rice Road
Waldron, AR 72958-7435 | 10/1/2018 12:11 PM |
Addresses | Billing Address | Insert | New Registration | | River Valley primary Care Services
9755 WEST STATE HWY 22
P.O. box 130
Ratcliff, AR 72951 | 10/1/2018 12:11 PM |
Contacts | Authorizing Official | Insert | New Registration | | WHITE, JERRY
CEO
River Valley primary Care Services
4796350091-240 | 10/1/2018 12:11 PM |
Contacts | Primary Contact | Insert | New Registration | | McKinney, Nikki
HR/Administrative Manager
RVPCS
4796350091-239 | 10/1/2018 12:11 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Details | Grant Number | Insert | New Registration | | H80CS04288 | 10/1/2018 12:11 PM |
Details | 340B ID | Insert | New Registration | | | 10/1/2018 12:11 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/1/2018 12:11 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/1/2018 12:11 PM |
Details | Medicare Provider Number | Insert | New Registration | | | 10/1/2018 12:11 PM |
Details | Entity Name | Insert | New Registration | | RIVER VALLEY PRIMARY CARE SERVICES | 10/1/2018 12:11 PM |
Details | Program Code | Insert | New Registration | | CH | 10/1/2018 12:11 PM |
Details | Entity Subname | Insert | New Registration | | Waldron Family Clinic | 10/1/2018 12:11 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Details | State | Insert | New Registration | | Pending | 10/1/2018 12:11 PM |
Dates | Registration Date | Insert | New Registration | | 10/1/2018 12:11:43 PM | 10/1/2018 12:11 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Dates | Start Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/1/2018 12:11 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/1/2018 12:11 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/1/2018 12:11 PM |