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CORNER DRUG STORE
CAH041310-00 White River Health System, Inc. DBA Stone County Medical Center
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Covered Entity Details
Entity Name
White River Health System, Inc. DBA Stone County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041310-00
Entity Address
2106 East Main Street
Mountain View, AR 72560
Medicare Provider Number
041310
Participating Start Date
10/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CORNER DRUG STORE
Pharmacy Address
CORNER DRUG STORE
LISAGARDNER99@MAC.COM
830 EAST MAIN STREET
MELBOURNE, AR 72556-7255
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jana Richardson, Controller
(870) 262-3222
Contract Pharmacy Representative
Caeverett, Inc.
Lisa Gardner, Owner
(870) 368-7171
Signed By Date
4/14/2015
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