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MIDLAND DRUG STORE
CH061202B RIVER VALLEY PRIMARY CARE SERVICES
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Covered Entity Details
Entity Name
RIVER VALLEY PRIMARY CARE SERVICES
Subdivision Name
RVPCS - NORTHSIDE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH061202B
Entity Address
4900 Kelley Hwy
Fort Smith, AR 72904-5000
Grant Number
H80CS04288
Participating Start Date
4/1/2009
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
4/16/2010
Contract Begin Date
4/16/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
4/8/2010
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