Contract Pharmacy Details

WALGREEN CO.
DSH040119 WHITE RIVER MEDICAL CENTER

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 # 09766
200 E RACE AVE
SEARCY, AR 72143

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

4/1/2019
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database