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DSH040119G WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
WRMC Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119G
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
16 Hospital Circle, Suite A
BATESVILLE, AR 72501-7343
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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