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DSH040119V WHITE RIVER MEDICAL CENTER (Approved)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
WHITE RIVER HEALTH SYSTEM INC - Rural Health Clinic XII Newport
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119V
Medicare Provider Number
040119
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/10/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/15/2025
Last Recertification Date
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
2200 MALCOLM AVE
STE B
NEWPORT, AR 72112-3697
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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