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DSH040119H WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
White River Medical Center Physicians Group/Pain Mgt.
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119H
Medicare Provider Number
040119
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/6/2014
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
1700 Harrison Street, Ste T
BATESVILLE, AR 72501
Billing Address
White River Health System, Inc.
PO Box 2197
BATESVILLE, AR 72503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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