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DSH040119A WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Midway Medical
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119A
Medicare Provider Number
040119
Outpatient Facility Provider Number
043981
Additional Details
Current Program Status
Active
Registration Date
1/11/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/7/2013
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
195 Hospital Drive, Suite C
Cherokee Village, AR 72529
Billing Address
Midway Medical
1950 Hospital Drive, Suite B
Cherokee Village, AR 72529
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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BL 02/21/13 Midway listed on line 88 of Worksheet C others to follow are on 88.01, 88.02, 88.03, 88.04, and 88.05 respectively.
02/21/2013
June 2025
June 2025
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