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WAL-MART PHARMACY 10-0055
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
WAL-MART PHARMACY 10-0055
Pharmacy Address
1400 EAST MAIN STREET
BOONEVILLE, AR 72927
Pharmacy Comments
Contract Details
Approval Date
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/5/2017
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