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DSH040119C WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Melbourne Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119C
Medicare Provider Number
040119
Outpatient Facility Provider Number
043997
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
1526 East Main Street
Melbourne, AR 72556
Billing Address
Melbourne Medical Clinic
PO Box 37
Melbourn, AR 72556
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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