CLIA lab
CLIA 04D2063021: Walgreens #21379
Pine Bluff, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2063021 belongs to Walgreens #21379 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
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
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
- July 25, 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
- 04D2063021
- Lab name
- Walgreens #21379
- Address
- 5905 Dollarway Rd, Pine Bluff, AR 71602
- Phone
- (873) 534-7868
- Fax
- (870) 534-4677
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.
Other labs in Pine Bluff, AR
- Ach Pine Bluff ClinicCertificate of Waiver, Physician office04D0465263
- Arcare 140Certificate of Waiver, Federally qualified health center04D2349439
- Arcare 155Certificate of Waiver, Federally qualified health center04D2325162
- Archwell Health - Pine BluffCertificate of Waiver, Physician office04D2315883
- Arkansas Dept of Correction Health SVCCertificate of Waiver, Other02D0682823
- Autonomy Healthcare ProvidersCertificate of Waiver, Physician office04D2271274
- Buckhanan RecoveryCertificate of Waiver, Other04D2299468
- Cavhs Pine BluffCertificate of Accreditation, Community clinic04D2185025
- Central Arkansas Radiation Therapy InstituteCertificate of Accreditation, Physician office04D2194416
- Children's Advocacy Center of Southeast ArkansasCertificate of Waiver, Other04D2275776
Related
Questions
What is the CLIA number for Walgreens #21379 in Pine Bluff?
04D2063021, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Walgreens #21379 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2063021 expire?
The CMS file lists April 26, 2027 as the certificate expiration date; the certificate took effect April 27, 2025.