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ECONO-MART PHARMACY INC
DSH040119 WHITE RIVER MEDICAL CENTER
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Covered Entity Details
Entity Name
WHITE RIVER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040119
Entity Address
1710 HARRISON STREET
BATESVILLE, AR 72501
Medicare Provider Number
040119
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
ECONO-MART PHARMACY INC
Pharmacy Address
1595 HARRISON ST
BATESVILLE, AR 72501
Pharmacy Comments
Contract Details
Approval Date
3/7/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jana Richardson, Interim CFO
(870) 262-3222
Contract Pharmacy Representative
Bryant's Pharmacy & Health Care Center
Steve Bryant, President
(870) 793-3999
Signed By Date
1/11/2013
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