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WALGREEN CO.
CH061202A RIVER VALLEY PRIMARY CARE SERVICES
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Covered Entity Details
Entity Name
RIVER VALLEY PRIMARY CARE SERVICES
Subdivision Name
RIVER VALLEY PRIMARY CARE SERVICES INC.
Type
HRSA-Funded Health Center
340B ID
CH061202A
Entity Address
9755 W State Highway 22
Ratcliff, AR 72951-9000
Grant Number
H80CS04288
Participating Start Date
11/14/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15797
1125 W. 2ND STREET
WALDRON, AR 72958
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY WHITE, CEO
(479) 431-2057 Ext: 9040
Contract Pharmacy Representative
Walgreens
Taylor Spiros, 340B Client Relationship Analyst
(847) 964-8689
Signed By Date
4/11/2018
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