CLIA lab

CLIA 04D2058918: Walgreens #15361

Pine Bluff, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.

CLIA number 04D2058918 belongs to Walgreens #15361 in Pine Bluff, AR.

Certificate of Waiver, effective April 27, 2025, expires April 26, 2027.

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
April 27, 2025
Certificate expiration
April 26, 2027
Status in the CMS file
Active (termination code 00)
Original participation date
May 14, 2013
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
04D2058918
Lab name
Walgreens #15361
Address
2503 W 28 Ave, Pine Bluff, AR 71603
Phone
(870) 850-6084
Fax
(870) 850-6361

Annual test volume the lab reported

Waived tests
12,775

Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.

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Related

Questions

What is the CLIA number for Walgreens #15361 in Pine Bluff?

04D2058918, per the CMS Provider of Services file posted October 16, 2026.

What CLIA certificate does Walgreens #15361 hold?

A Certificate of Waiver, according to the CMS file.

When does CLIA 04D2058918 expire?

The CMS file lists April 26, 2027 as the certificate expiration date; the certificate took effect April 27, 2025.

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