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DSH040119P WHITE RIVER MEDICAL CENTER (Active)
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Main Details
Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Pulmonology Clinic II / Pulmonology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH040119P
Medicare Provider Number
040119
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
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 C
Batesville, AR 72501
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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