340B Drug Pricing Program Database

Name

WHITE RIVER MEDICAL CENTER

Subdivision Name

Family Care Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH040119Q

Medicare Provider Number

040119

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

4/7/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/26/2017

Last Recertification Date

Termination Date
Termination Reason

1/1/2018
Business decision by the Covered Entity

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

Street Address

1215 Sidney Street
Suite 300
Batesville, AR 72501

Billing Address
Same as Street Address