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DSH040119E WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Drasco Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119E
Medicare Provider Number
040119
Outpatient Facility Provider Number
043455
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
60 Greers Ferry Road
Drasco, AR 72530-9130
Billing Address
Drasco Medical Clinic
PO Box 99
Drasco, AR 72530-0099
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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