Covered Entity Details

CH061202L RIVER VALLEY PRIMARY CARE SERVICES (Active) - information as of 5/20/2025 11:45:15 PM

Main Details

Name

RIVER VALLEY PRIMARY CARE SERVICES

Subdivision Name

Bonanza Wellness Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030471

340B ID

CH061202L

Grant Number

H80CS04288

Additional Details

Current Program Status

Active

Registration Date

4/8/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/22/2020

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

River Valley primary Care Services
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040

Primary Contact

RVPCS
Claire Elizabeth Yates, 340B Coordinator
(479) 431-2050 Ext: 9034

Addresses

Street Address

920 State Highway 45
Bonanza, AR 72916

Billing Address

River Valley Primary Care Services
PO Box 130
Ratcliff, AR 72951

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH061202A	Active	BPS-H80-003040	RIVER VALLEY PRIMARY CARE SERVICES	RIVER VALLEY PRIMARY CARE SERVICES INC.	9755 W State Highway 22	Ratcliff	AR
CH061202B	Active	BPS-H80-003281	RIVER VALLEY PRIMARY CARE SERVICES	RVPCS - NORTHSIDE CLINIC	4900 Kelley Hwy	Fort Smith	AR
CH061202C	Active	BPS-H80-019334	RIVER VALLEY PRIMARY CARE SERVICES	Mulberry Family Clinic	421 North Main Street	Mulberry	AR
CH061202D	Active	BPS-H80-009100	RIVER VALLEY PRIMARY CARE SERVICES	Mountainburg Family Clinic	4 Highway 71 North	Mountainburg	AR
CH061202E	Active	BPS-H80-012820	RIVER VALLEY PRIMARY CARE SERVICES	RVPCS-Eastside Family Clinic	4003 Massard Rd	Fort Smith	AR
CH061202F	Active	BPS-H80-012808	RIVER VALLEY PRIMARY CARE SERVICES	Lamar School District Health Center	635 Childers Street	Lamar	AR
CH061202G	Active	BPS-H80-008130	RIVER VALLEY PRIMARY CARE SERVICES	Northside Clinic at 6th Street	3202 N 6th St	Fort Smith	AR
CH061202H	Active	BPS-H80-021894	RIVER VALLEY PRIMARY CARE SERVICES	Waldron Family Clinic	2074 Rice Road	Waldron	AR
CH061202J	Active	BPS-H80-024979	RIVER VALLEY PRIMARY CARE SERVICES	Clarksville Community Health Center	708 W Main St	Clarksville	AR
CH061202K	Active	BPS-H80-028170	RIVER VALLEY PRIMARY CARE SERVICES	Lavaca Wellness Center	603 S Division St	Lavaca	AR
CH061202L	Active	BPS-H80-030471	RIVER VALLEY PRIMARY CARE SERVICES	Bonanza Wellness Center	920 State Highway 45	Bonanza	AR
CH061202M	Active	BPS-H80-032903	RIVER VALLEY PRIMARY CARE SERVICES	Clarksville Behavioral Health	106 N Hill St	Clarksville	AR
CH061202N	Active	BPS-H80-032902	RIVER VALLEY PRIMARY CARE SERVICES	RVPCS - Coal Hill Family Clinic	1273 Hwy 64 East	Coal Hill	AR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH061202A	ALLCARE PHARMACY	508 E WALNUT ST		PARIS	AR	72855-4019	04/01/2016	12/09/2020
CH061202A	BURNS DRUG INC	615 W COMMERCIAL		OZARK	AR	72949-3113	10/01/2013	06/27/2018
CH061202A	CLARKSVILLE FAMILY PHARMACY	510 S ROGERS ST STE 3		CLARKSVILLE	AR	72830-3792	10/01/2019	10/12/2023
CH061202A	COLEMAN BUTLER FT SMITH, LLC	DBA COLEMAN PHARMACY	3610 GRAND AVE COLEMAN PHARMACY	FORT SMITH	AR	72904	04/01/2018	03/30/2018
CH061202A	COLEMAN BUTLER FT SMITH, LLC	DBA COLEMAN PHARMACY	3610 GRAND AVE COLEMAN PHARMACY	FORT SMITH	AR	72904	01/28/2020
CH061202A	COLEMAN PHARMACY INC	3610 GRAND AVE		FORT SMITH	AR	72904	01/01/2015	03/30/2018
CH061202B	COLEMAN PHARMACY INC	3610 GRAND AVE		FORT SMITH	AR	72904	04/01/2009
CH061202A	COLEMAN PHARMACY OF ALMA	110 FAYETTEVILLE AVE		ALMA	AR	72921-3654	03/15/2012	06/27/2018
CH061202D	COLEMAN PHARMACY OF ALMA	110 FAYETTEVILLE AVE		ALMA	AR	72921-3654	06/18/2010
CH061202A	D&D PHARMACY LLC	8908 KANIS ROAD, SUITE 350		LITTLE ROCK	AR	72205	01/01/2020	09/22/2020
CH061202A	FRED'S PHARMACY #1386	409 WEST MAIN		CLARKSVILLE	AR	72830	10/01/2017	07/18/2018
CH061202A	HEALTH DEPOT #1	7700 HIGHWAY 271 S		FORT SMITH	AR	72908-8028	01/01/2020	09/27/2023
CH061202A	HEALTH DEPOT #2	1610 FORT ST		BARLING	AR	72923-2018	01/01/2020	09/27/2023
CH061202A	HEALTH DEPOT #3	1530 W CENTER ST		GREENWOOD	AR	72936-3400	01/01/2020	09/27/2023
CH061202A	HEALTH-WISE PHARMACY	1800 W MAIN ST		LAVACA	AR	72941-3802	01/01/2020	10/31/2023
CH061202A	HEALTH-WISE PHARMACY	47 HIGHWAY 71 BYP S		WALDRON	AR	72958	01/01/2020	06/20/2022
CH061202A	HNK PHARM, PLLC	1800 W MAIN ST		LAVACA	AR	72941	04/01/2024
CH061202A	MEDI SAV PHARMACY #2	8820 ROGERS AVE		FORT SMITH	AR	72903-5245	11/29/2011	12/16/2024
CH061202A	MEDI-QUIK DISCOUNT PHARMACY#3, INC.		406 E. WALNUT	PARIS	AR	72855	09/10/2009	10/31/2016
CH061202A	MEDI-QUIK PHARMACY	810 W COMMERCIAL ST		OZARK	AR	72949	05/01/2010
CH061202A	MEDI-QUIK PHARMACY BOONEVILLE	1531 E MAIN ST		BOONEVILLE	AR	72927-4921	11/09/2012	05/06/2021
CH061202A	MEDI-QUIK PHARMACY BOONEVILLE	1531 E MAIN ST		BOONEVILLE	AR	72927-4921	10/01/2024
CH061202A	MEDI-SAV PHARMACY #1	621 E MAIN ST	PO BOX 8	CHARLESTON	AR	72933-9328	11/29/2011	12/16/2024
CH061202A	MIDLAND DRUG STORE	4900 KELLEY HWY		FORT SMITH	AR	72904	01/01/2015	09/16/2023
CH061202B	MIDLAND DRUG STORE	4900 KELLEY HWY		FORT SMITH	AR	72904	04/16/2010
CH061202A	MILLER PRINCIPLE MANAGEMENT LLC	DBA SCOTT COUNTY DRUG	47 HIGHWAY 71 BYP S	WALDRON	AR	72958	01/01/2025
CH061202A	MULBERRY MEDI-QUIK PHARMACY, INC.	442 N MAIN ST	P. O. BOX 390	MULBERRY	AR	72947-8574	01/01/2015	10/07/2019
CH061202C	MULBERRY MEDI-QUIK PHARMACY, INC.	442 N MAIN ST	P. O. BOX 390	MULBERRY	AR	72947-8574	03/15/2010
CH061202A	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	01/01/2020	09/22/2020
CH061202A	ROSE DRUG OF CLARKSVILLE INC	211 E MAIN ST		CLARKSVILLE	AR	72830-3723	04/01/2019	06/07/2019
CH061202A	RVPCS COMMUNITY PHARMACY	9755 W. STATE HIGHWAY 22		RATCLIFF	AR	72951	04/01/2021	04/01/2021
CH061202A	VILLAGE PHARMACY	VILLAGE PHARMACY	500 W COMMERCIAL ST	OZARK	AR	72949	04/01/2019
CH061202A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019
CH061202A	WAL-MART PHARMACY 10-0016	2214 FAYETTEVILLE ROAD		VAN BUREN	AR	72956	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0055	1400 EAST MAIN STREET		BOONEVILLE	AR	72927	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0066	230 MARKET ST		CLARKSVILLE	AR	72830-9069	07/01/2018
CH061202A	WAL-MART PHARMACY 10-0125	2425 SOUTH ZERO ST.		FORT SMITH	AR	72901	04/01/2019
CH061202A	WAL-MART PHARMACY 10-0141	8301 ROGERS AVENUE		FORT SMITH	AR	72903	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0209	1516 NORTH 18TH STREET		OZARK	AR	72949	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0230	1501 EAST WALNUT	P O BOX 629	PARIS	AR	72855	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0358	367 WEST CHERRY ST		ALMA	AR	72921	04/01/2017
CH061202A	WAL-MART PHARMACY 10-0388	2100 NORTH 62ND STREET		FORT SMITH	AR	72904	04/01/2017
CH061202A	WAL-MART PHARMACY 10-2744	4900 ROGERS AVENUE	SUITE 101J	FORT SMITH	AR	72903	07/01/2018
CH061202A	WAL-MART PHARMACY 10-3231	551 LIBERTY DR		GREENWOOD	AR	72936	04/01/2019
CH061202A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH061202A	WALGREEN CO	DBA: WALGREENS #11987	323 HIGHWAY 64 W	ALMA	AR	72921	12/28/2011
CH061202A	WALGREEN CO.	DBA: WALGREENS # 05260	2701 ROGERS AVE	FT SMITH	AR	72901	12/28/2011
CH061202A	WALGREEN CO.	DBA: WALGREENS # 07234	8300 ROGERS AVENUE	FT SMITH	AR	72903-5235	12/28/2011
CH061202A	WALGREEN CO.	DBA: WALGREENS # 07235	1601 FAYETTEVILLE ROAD	VAN BUREN	AR	72956-2230	12/28/2011	05/12/2025
CH061202A	WALGREEN CO.	DBA: WALGREENS # 09594	1925 S ZERO ST	FORT SMITH	AR	72901	12/28/2011
CH061202A	WALGREEN CO.	DBA: WALGREENS # 10199	1100 E MAIN ST	RUSSELLVILLE	AR	72801-5319	04/01/2017
CH061202A	WALGREEN CO.	WALGREENS #15797	1125 W. 2ND STREET	WALDRON	AR	72958	07/01/2018
CH061202A	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	07/01/2024
CH061202A	WALMART PHARMACY 10-4579	8600 US 71 SOUTH		FORT SMITH	AR	72908	04/01/2019
CH061202A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH061202A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Recertification	920 Highway 45 S Bonanza, AR 72916	920 State Highway 45 Bonanza, AR 72916	2/12/2025 8:27 AM
Details	Last Recertification Date	Update	Recertification	2/1/2024 10:16:20 AM	2/12/2025 8:27:23 AM	2/12/2025 8:27 AM
Details	Last Recertification Date	Update	Recertification	2/3/2023 11:49:27 AM	2/1/2024 10:16:20 AM	2/1/2024 10:16 AM
Addresses	Billing Address	Insert	Recertification		River Valley Primary Care Services PO Box 130 Ratcliff, AR 72951	2/3/2023 11:49 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 11:37:04 AM	2/3/2023 11:49:27 AM	2/3/2023 11:49 AM
Details	Last Recertification Date	Update	Recertification	2/2/2021 5:40:37 PM	1/31/2022 11:37:04 AM	1/31/2022 11:37 AM
Details	Last Recertification Date	Update	Recertification		2/2/2021 5:40:37 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
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		WHITE, JERRY CEO River Valley primary Care Services 4794312057-9040	4/22/2020 8:26 AM
Details	340B ID	Update	New Registration		CH061202L	4/22/2020 8:26 AM
Dates	Participating Approval Date	Update	New Registration		4/22/2020 8:26:01 AM	4/22/2020 8:26 AM
Details	State	Update	New Registration	Pending	Approved	4/22/2020 8:26 AM
Dates	Signed By Date	Update	New Registration		4/14/2020 10:10:38 AM	4/22/2020 8:26 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/22/2020 8:26 AM
Addresses	Main Address	Insert	New Registration		920 Highway 45 S Bonanza, AR 72916	4/8/2020 2:01 PM
Contacts	Authorizing Official	Insert	New Registration		WHITE, JERRY CEO River Valley primary Care Services 4794312057-9040	4/8/2020 2:01 PM
Contacts	Primary Contact	Insert	New Registration		Hamilton, Marcy Controller River Valley Primary Care Services, Inc. 4794312057	4/8/2020 2:01 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2020 2:01 PM
Details	Grant Number	Insert	New Registration		H80CS04288	4/8/2020 2:01 PM
Details	340B ID	Insert	New Registration			4/8/2020 2:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2020 2:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2020 2:01 PM
Details	Medicare Provider Number	Insert	New Registration			4/8/2020 2:01 PM
Details	Entity Name	Insert	New Registration		RIVER VALLEY PRIMARY CARE SERVICES	4/8/2020 2:01 PM
Details	Program Code	Insert	New Registration		CH	4/8/2020 2:01 PM
Details	Entity Subname	Insert	New Registration		Bonanza Wellness Center	4/8/2020 2:01 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2020 2:01 PM
Details	State	Insert	New Registration		Pending	4/8/2020 2:01 PM
Dates	Registration Date	Insert	New Registration		4/8/2020 2:01:18 PM	4/8/2020 2:01 PM
Dates	Signed By Date	Insert	New Registration			4/8/2020 2:01 PM
Dates	Start Date	Insert	New Registration			4/8/2020 2:01 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2020 2:01 PM
Terminations	Termination Date	Insert	New Registration			4/8/2020 2:01 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2020 2:01 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2020 2:01 PM

340B Drug Pricing Program Database