CLIA lab
CLIA 04D1021894: Kroger Pharmacy #624
Russellville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1021894 belongs to Kroger Pharmacy #624 in Russellville, AR.
Certificate of Waiver, effective February 3, 2026, expires February 2, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- February 3, 2026
- Certificate expiration
- February 2, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 3, 2004
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 04D1021894
- Lab name
- Kroger Pharmacy #624
- Address
- 1003 West Main St, Russellville, AR 72801
- Phone
- (479) 880-1877
- Fax
- (479) 880-1843
Annual test volume the lab reported
- Waived tests
- 3,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Russellville, AR
- Ar Heart Hospital Rural Health Svcs - RussellvilleCertificate of Waiver, Physician office04D1096786
- Arcare 92Certificate of Waiver, Federally qualified health center04D2308343
- Arcare 98Certificate of Waiver, Federally qualified health center04D2329669
- Arkansas DermatologyCertificate of Compliance, Physician office04D2178013
- Arkansas Dermatology CenterCertificate for Provider-Performed Microscopy Procedures, Physician office04D0949890
- Arkansas Occupational Health Clinic - RussellvilleCertificate of Waiver, Physician office04D2119425
- Arkansas Renal Group, PA - RussellvilleCertificate of Waiver, Physician office04D2112078
- Arkansas Tech University Health & Wellness CenterCertificate for Provider-Performed Microscopy Procedures, School or student health service04D0909870
- Arkansas Urology/RussellvilleCertificate for Provider-Performed Microscopy Procedures, Physician office04D1100397
- BPC Plasma, IncCertificate of Accreditation, Independent04D2162256
Related
Questions
What is the CLIA number for Kroger Pharmacy #624 in Russellville?
04D1021894, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Kroger Pharmacy #624 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1021894 expire?
The CMS file lists February 2, 2028 as the certificate expiration date; the certificate took effect February 3, 2026.