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ASHFLAT PHARMACY
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
ASHFLAT PHARMACY
Pharmacy Address
JENNINGS DAVID T PROP
970 D ASHFLAT DRIVE
PO BOX 278
ASH FLAT, AR 72513
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
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
Ash Flat Pharmacy
David Jennings, President
(870) 994-7377
Signed By Date
4/15/2015
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