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CAEVERETT, INC.
DSH040119 WHITE RIVER MEDICAL CENTER
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Covered Entity Details
Entity Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040119
Entity Address
1710 HARRISON STREET
BATESVILLE, AR 72501
Medicare Provider Number
040119
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CAEVERETT, INC.
Pharmacy Address
CORNER DRUG STORE
830 MAIN ST
MELBOURNE, AR 72556-8205
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
1/10/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shawna Jeffrey Ives, Controller
(870) 262-6100
Contract Pharmacy Representative
Caeverett
Abby Everett, Pharmacist
(870) 368-7171
Signed By Date
1/10/2020
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