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DSH040069 GREAT RIVER MEDICAL CENTER (Active)
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Main Details
Name
GREAT RIVER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040069
Medicare Provider Number
040069
Additional Details
Current Program Status
Active
Registration Date
1/16/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/9/2020
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Mississippi County Hospital System
Felicia Pierce, COO/CNO
(870) 838-7463
Primary Contact
Mississippi County Hospital System
Matt Nichols, CFO
(870) 838-7466
Addresses
Street Address
1520 NORTH DIVISION ST
BLYTHEVILLE, AR 72315
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2011, terminated 1/2/2014. Reinstated 4/1/2020.
02/03/2020
April 2025
April 2025
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