CLIA lab
CLIA 04D2138568: Wagner's Mount Ida Pharmacy
Mount Ida, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2138568 belongs to Wagner's Mount Ida Pharmacy in Mount Ida, AR.
Certificate of Waiver, effective October 20, 2025, expires October 19, 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
- October 20, 2025
- Certificate expiration
- October 19, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- October 20, 2017
- 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
- 04D2138568
- Lab name
- Wagner's Mount Ida Pharmacy
- Address
- 744 Hwy 270EAST, Mount Ida, AR 71957
- Phone
- (870) 867-3174
- Fax
- (870) 867-2033
Annual test volume the lab reported
- Waived tests
- 200
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Mount Ida, AR
- Chi ST Vincent Medcial Group Hot SpringsCertificate of Compliance, Physician office04D0466068
- Healthy Connections-Montgomery Community ClinicCertificate of Waiver, Federally qualified health center04D1078542
- Montgomery County Nursing HomeCertificate of Waiver, Skilled nursing or nursing facility04D0883592
- Montogomery County Assisted LivingCertificate of Waiver, Other04D2196227
Related
Questions
What is the CLIA number for Wagner's Mount Ida Pharmacy in Mount Ida?
04D2138568, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Wagner's Mount Ida Pharmacy hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2138568 expire?
The CMS file lists October 19, 2027 as the certificate expiration date; the certificate took effect October 20, 2025.