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DSH040119F WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Strawberry Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119F
Medicare Provider Number
040119
Outpatient Facility Provider Number
043467
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
58 East River Drive
Strawberry, AR 72469
Billing Address
White River Health System, d/b/s Strawberry Clnic
PO Box 140
Strawberry, AR 72469
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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