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DSH040119S WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
WHITE RIVER HEALTH SYSTEM, INC. - Rural Health Clinic IX Virginia Dr
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119S
Medicare Provider Number
040119
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/13/2024
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
White River Health System
Shawna Jeffrey Ives, Controller
(870) 262-6100
Primary Contact
White River Medical Center
Maggie Williams, Pharmacy Director
(870) 262-6095
Addresses
Street Address
409 VIRGINIA DRIVE
WHITE RIVER HEALTH FAMILY CARE
BATESVILLE, AR 72501
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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