Contract Pharmacy Details

PALACE DRUG
DSH040014 WHITE COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

WHITE COUNTY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH040014

Entity Address

3214 East Race Avenue
SEARCY, AR 72143

Medicare Provider Number

040014

Participating Start Date

4/1/2015

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

PALACE DRUG

Pharmacy Address

313 MAIN ST
DES ARC, AR 72040

Pharmacy Comments

Contract Details

Approval Date

4/10/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stuart Randall Hill, VP Treasurer
(501) 380-1004

Contract Pharmacy Representative

Palace Drug
Peyton Harvey, Owner
(501) 516-6451

Signed By Date

4/10/2024