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CLARKSVILLE FAMILY PHARMACY
CH061202A RIVER VALLEY PRIMARY CARE SERVICES
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Covered Entity Details
Entity Name
RIVER VALLEY PRIMARY CARE SERVICES
Subdivision Name
RIVER VALLEY PRIMARY CARE SERVICES INC.
Type
HRSA-Funded Health Center
340B ID
CH061202A
Entity Address
9755 W State Highway 22
Ratcliff, AR 72951-9000
Grant Number
H80CS04288
Participating Start Date
11/14/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CLARKSVILLE FAMILY PHARMACY
Pharmacy Address
510 S ROGERS ST STE 3
CLARKSVILLE, AR 72830-3792
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040
Contract Pharmacy Representative
Clarksville Family Pharmacy
Charles Ward Lee, President
(479) 647-3138
Signed By Date
7/15/2019
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