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CORNERSTONE PHARMACY AT GREERS FERRY
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
CORNERSTONE PHARMACY AT GREERS FERRY
Pharmacy Address
8470 EDGEMONT RD
GREERS FERRY, AR 72067
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jana Richardson, Controller
(870) 262-3222
Contract Pharmacy Representative
Chad Vance, Pharmacist in Charge
(501) 580-1895
Signed By Date
4/13/2016
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