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ICARERX PHARMACY
DSH040014 WHITE COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
WHITE COUNTY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040014
Entity Address
3214 East Race Avenue
SEARCY, AR 72143
Medicare Provider Number
040014
Participating Start Date
4/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
ICARERX PHARMACY
Pharmacy Address
ICARERX PHARMACY
1117 MCLAIN ST STE 400
NEWPORT, AR 72112-3545
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Randall Hill, VP Treasurer
(501) 380-1004
Contract Pharmacy Representative
Rx Hound Inc
Eric Shoffner, Owner
(870) 523-5555
Signed By Date
7/12/2018
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