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MIDLAND DRUG STORE
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
MIDLAND DRUG STORE
Pharmacy Address
4900 KELLEY HWY
FORT SMITH, AR 72904
Pharmacy Comments
Contract Details
Approval Date
10/13/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/16/2023
Ownership change
Contacts
Covered Entity Signing Official
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040
Contract Pharmacy Representative
Kris Gilsinger, Pharmacist
(479) 783-0221
Signed By Date
10/13/2014
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