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MEDI-SAV PHARMACY #1
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
MEDI-SAV PHARMACY #1
Pharmacy Address
621 E MAIN ST
PO BOX 8
CHARLESTON, AR 72933-9328
Pharmacy Comments
Contract Details
Approval Date
11/29/2011
Contract Begin Date
11/29/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040
Contract Pharmacy Representative
Keith Larkin, Owner
(479) 452-0278
Signed By Date
11/15/2011
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