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DSH040119K WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
WRMC Medical Complex Emergency Room
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119K
Medicare Provider Number
040119
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
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
197 Hospital Dr. Suite C
Cherokee Village, AR 72529-7330
Billing Address
White River Medical Center
PO Box 2197
Batesville, AR 72503-2197
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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