340B Drug Pricing Program Database

Name

WHITE RIVER MEDICAL CENTER

Subdivision Name

WRMC Internal Medicine Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH040119M

Medicare Provider Number

040119

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

4/14/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/20/2016

Last Recertification Date

8/22/2016

Termination Date
Termination Reason

7/1/2017
For-Profit conversion

Authorizing Official

White River Health System
Shawna Jeffrey Ives, Controller
(870) 262-6100

Primary Contact

White River Medical Center
Jana Richardson, Controller
(870) 262-3222

Street Address

12 Hospital Circle, Suite B
Batesville, AR 72501

Billing Address
Same as Street Address