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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11161
2401 MALCOLM AVE
NEWPORT, AR 72112
Pharmacy Comments
Contract Details
Approval Date
2/25/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/27/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Jana Richardson, Interim CFO
(870) 262-3222
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2013
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