CLIA lab
CLIA 04D2102175: Kroger Pharmacy #629
Benton, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2102175 belongs to Kroger Pharmacy #629 in Benton, AR.
Certificate of Waiver, effective September 17, 2025, expires September 16, 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
- September 17, 2025
- Certificate expiration
- September 16, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 17, 2015
- 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
- 04D2102175
- Lab name
- Kroger Pharmacy #629
- Address
- 20820 I-30 North, Benton, AR 72019
- Phone
- (501) 574-3884
- Fax
- (501) 574-3887
Annual test volume the lab reported
- Waived tests
- 500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Benton, AR
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- Amberwood Health and RehabilitationCertificate of Waiver, Skilled nursing or nursing facility04D2140547
- Arcare 121Certificate of Waiver, Federally qualified health center04D2160874
- Archer - Knight Health and Wellness, PLLCCertificate of Waiver, Other practitioner04D2317688
- Arkansas Cardiology BentonCertificate of Waiver, Physician office04D2347965
- Arkansas Health CenterCertificate of Waiver, Skilled nursing or nursing facility04D0677254
- Arkansas Urology-BentonCertificate for Provider-Performed Microscopy Procedures, Physician office04D0466136
- Baptist Health Imaging CTR Saline CountyCertificate of Waiver, Other04D2027600
- Baptist Health Urgent Care-Benton, ArCertificate of Waiver, Physician office04D2136064
- Benton DialysisCertificate of Waiver, End stage renal disease dialysis facility04D0955645
Related
Questions
What is the CLIA number for Kroger Pharmacy #629 in Benton?
04D2102175, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Kroger Pharmacy #629 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2102175 expire?
The CMS file lists September 16, 2027 as the certificate expiration date; the certificate took effect September 17, 2025.