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DSH040004 WASHINGTON REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
WASHINGTON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH040004
Medicare Provider Number
040004
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
1/1/2022
DSH percentage below statutory minimum
Contacts
Authorizing Official
Washington Regional Medical System
Dan Ray Eckels, Sr VP & CFO
(479) 463-2825 Ext: 4794636026
Primary Contact
Washington Regional Medical System
Daniel Bishop, Director of Pharmacy
(479) 463-1122
Addresses
Street Address
3215 N. NORTH HILLS BLVD
FAYETTEVILLE, AR 72703
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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