Covered Entity Details

DSH280013 THE NEBRASKA MEDICAL CENTER (Active) - information as of 5/26/2025 12:51:17 AM

Main Details

Name

THE NEBRASKA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH280013

Medicare Provider Number

280013

Additional Details

Current Program Status

Active

Registration Date

9/8/2007

Participating Start Date

12/1/1992

Participating Approval Date

9/10/2007

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Nebraska Medical Center
Stephanie Daubert, CFO
(402) 552-2889

Primary Contact

The Nebraska Medical Center
Kathy A Yochum, Manager 340B, Contract Pharmacy 340B Program
(402) 559-6320

Addresses

Street Address

989200 Nebraska Medical Center
Omaha, NE 68198

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/10/09 ADDED SHIP TO; 10/8/09 UPDATED ENTITY NAME (WAS UNIVERSITY OF NEBRASKA MEDICAL CENTER); 9/25/09 UPDATED ADDR (WAS 4401 DEWEY AVE); 9/25/09 ADDED SHIP TO 12/16/10ADDED MEDICAID#911858433-02	12/16/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NE	91185843326	1942368352,1780135319,1356307581,1467529727,1972247799,1285394049,1477264596,1770266546,1750130118
IA		1356307581,1467529727,1780135319,1942368352,1972247799,1285394049,1477264596,1770266546,1750130118

Shipping Addresses

Shipping Address 1

UNIVERSITY HOSPITAL PHARMACY
981090 NEBRASKA MEDICAL CENTER
OMAHA, NE 68198

Shipping Address 2

UNIVERSITY OF NEBRASKA MEDICAL CENTER
4401 DEWEY AVE.
OMAHA, NE 68198

Shipping Address 3

THE NEBRASKA MEDICAL CENTER BELLEVUE PHARMACY
2510 BELLEVUE MEDICAL CENTER DR
SUITE 100
BELLEVUE, NE 68123

Shipping Address 4

The Nebraska Medical Center
987400 Nebraska Medical Center
Omaha, NE 68198

Shipping Address 5

NEBRASKA MEDICINE HUB PHARMACY
770 N 114TH ST
OMAHA, NE 68154-1572

Shipping Address 6

Nebraska Medicine Kearney Pharmacy
412 W 42nd Street RM #7
Kearney, NE 68845

Shipping Address 7

NEBRASKA MEDICINE VILLAGE POINTE PHARMACY
17405 Burke ST
STE 0026
Omaha, NE 68118

Shipping Address 8

The Nebraska Medical Center Clinic Pharmacy
989200 Nebraska Medical Center
Omaha, NE 68198-9200

Shipping Address 9

Nebraska Medicine Pharmacy at Lauritzen Outpatient Center
4014 Leavenworth St
Omaha, NE 68198

Shipping Address 10

NEBRASKA MEDICINE HOME INFUSION PHARMACY
12565 W Center RD
STE 120
Omaha, NE 68144

Shipping Address 11

Nebraska Medical Center Biologics Production Facility
4215 Emile Street
Omaha, NE 68198

Shipping Address 12

Nebraska Medicine Kearney Pharmacy
2232 Chancellors Ave
Room 1051
Kearney, NE 68845

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/09/2014	01/01/2015		01/10/2017
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	10/09/2014	01/01/2015	01/09/2017	01/10/2017
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/09/2014	01/01/2015		01/10/2017
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/11/2017	07/01/2017		04/11/2017
Contract Detail	ACCREDO HEALTH GROUP INC	19060 Q ST STE 101		OMAHA	NE	68135-1504	04/07/2020	07/01/2020		07/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/09/2014	01/01/2015	07/31/2023	10/08/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/09/2014	01/01/2015	07/13/2018	07/13/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.		PHARMACY 2 BOULDEN CIRCLE SUITE 1	NEW CASTLE	DE	19720	01/09/2015	04/01/2015	04/16/2018	04/17/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/06/2015	10/01/2015	07/13/2018	07/13/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/17/2022	04/01/2022		04/01/2022
Contract Detail	AMBER PHARMACY	AMBER ENTERPRISES, INC.	10004 S 152ND STREET SUITE A	OMAHA	NE	68138-3931	10/10/2019	01/01/2020		01/01/2020
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/15/2019	07/01/2019	09/11/2020	09/14/2020
Contract Detail	BAKER'S PHARMACY	13250 W. MAPLE ROAD		OMAHA	NE	68164	10/24/2013	01/01/2014		01/10/2017
Contract Detail	BAKER'S PHARMACY	17370 LAKESIDE HILLS PLAZA		OMAHA	NE	68130	10/24/2013	01/01/2014		01/10/2017
Contract Detail	BAKER'S PHARMACY	505 N. 155TH PLAZA		OMAHA	NE	68154	07/13/2018	10/01/2018		10/01/2018
Contract Detail	BAKER'S PHARMACY	5555 N. 90TH STREET		OMAHA	NE	68134	07/13/2018	10/01/2018		10/01/2018
Contract Detail	BAKER'S PHARMACY	7312 N. 30TH STREET		OMAHA	NE	68112	07/13/2018	10/01/2018		10/01/2018
Contract Detail	BAKER'S PHARMACY # 300	3614 TWIN CREEK DRIVE		BELLEVUE	NE	68123	10/24/2013	01/01/2014		01/10/2017
Contract Detail	BAKER'S PHARMACY # 301	4405 NORTH 72ND STREET		OMAHA	NE	68134	10/24/2013	01/01/2014		01/10/2017
Contract Detail	BAKER'S PHARMACY # 302	12025 WEST CENTER ROAD		OMAHA	NE	68144	07/13/2018	10/01/2018		10/01/2018
Contract Detail	BAKER'S PHARMACY #318	801 GALVIN ROAD		BELLEVUE	NE	68005	07/13/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/13/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/13/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/07/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/07/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/13/2017	10/01/2017		10/01/2017
Contract Detail	CRESCENT HEALTHCARE, INC.	CRESCENT HEALTHCARE	11980 TELEGRAPH RD STE 102	SANTA FE SPRINGS	CA	90670-6087	01/12/2024	04/01/2024		04/01/2024
Contract Detail	CRITICAL CARE SYSTEMS, LLC	D/B/A OPTION CARE	11372 AURORA AVENUE	URBANDALE	IA	50322	07/18/2016	10/01/2016	04/16/2018	04/17/2018
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/14/2022	10/01/2022		10/01/2022
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	04/14/2015	07/01/2015	08/09/2017	08/12/2017
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	06/29/2017	07/01/2017		06/29/2017
Contract Detail	DILLON COMPANIES, LLC	DBA BAKER'S PHARMACY #319	888 S SADDLECREEK RD	OMAHA	NE	68106-1959	10/24/2013	01/01/2014		01/10/2017
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/15/2020	01/01/2021	02/01/2023	02/01/2023
Contract Detail	ELMWOOD PHARMACY	KILBORNS INC. DBA ELMWOOD PHARMACY	5203 LEAVENWORTH ST	OMAHA	NE	68106	07/15/2020	10/01/2020		10/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/17/2018	07/01/2018		04/17/2018
Contract Detail	HY VEE PHARMACY	747 N 132ND ST		OMAHA	NE	68154	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE	8809 W. CENTER ST.		OMAHA	NE	68124	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE 1514	11650 S 73RD ST		PAPILLION	NE	68046	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE DRUGSTORE #7062	8404 N. 30TH ST		OMAHA	NE	68112	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE DRUGSTORE PHARMACY #7030	757 W. BROADWAY		COUNCIL BLUFFS	IA	51501	07/13/2017	10/01/2017	09/27/2020	10/01/2020
Contract Detail	HY-VEE FOOD STORES INC	5150 CENTER		OMAHA	NE	68106	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY	9707 Q ST		OMAHA	NE	68127	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY	14591 STONY BROOK BLVD		OMAHA	NE	68137	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY	10808 FORT ST		OMAHA	NE	68164	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY	17810 WELCH PLAZA		OMAHA	NE	68135	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY #1101	10 HY-VEE DRIVE		COUNCIL BLUFFS	IA	51503	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY #5 (1470)	7910 CASS STREET		OMAHA	NE	68114	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY (1092)	HY VEE INC	2323 WEST BROADWAY	COUNCIL BLUFFS	IA	51501	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY (1221)	115 WILMAR AVE		GRAND ISLAND	NE	68803	04/07/2020	07/01/2020		07/01/2020
Contract Detail	HY-VEE PHARMACY (1474)	3410 N. 156TH STREET		OMAHA	NE	68116-2020	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE PHARMACY FULFILLMENT CENTER 4016	HY-VEE INC	4707 FLUER DR	DES MOINES	IA	50321	07/13/2017	10/01/2017	04/16/2018	04/17/2018
Contract Detail	HY-VEE PHARMACY SOLUTIONS	HYVACS, LLC	10004 S. 152ND ST., SUITE C	OMAHA	NE	68138	10/10/2019	01/01/2020		01/01/2020
Contract Detail	HY-VEE PHARMACY SOLUTIONS	HYVACS LLC	215 10TH ST STE 110	DES MOINES	IA	50309-3608	10/10/2019	01/01/2020		01/01/2020
Contract Detail	HY-VEE, INC.	DBA: HY-VEE PHARMACY #1478	1000 S 178TH ST	OMAHA	NE	68118	07/13/2017	10/01/2017		10/01/2017
Contract Detail	HY-VEE, INC.	DBA: HY-VEE PHARMACY #1527	16418 WESTSIDE DR	PLATTSMOUTH	NE	68048	07/13/2017	10/01/2017		10/01/2017
Contract Detail	INFUSION THERAPY SPECIALISTS INC	DBA BIOSCRIP INFUSION SERVICES	8710 F STREET STE 118	OMAHA	NE	68127-1532	07/15/2016	10/01/2016	01/07/2019	01/07/2019
Contract Detail	KOHLL'S PHARMACY & HOMECARE	2923 LEAVENWORTH ST		OMAHA	NE	68105-2739	04/10/2015	07/01/2015	04/15/2019	04/15/2019
Contract Detail	KOHLL'S PHARMACY & HOMECARE		3427 SOUTH 84TH STREET	OMAHA	NE	68124	04/10/2015	07/01/2015	08/01/2016	01/10/2017
Contract Detail	KOHLL'S PHARMACY & HOMECARE	5000 DODGE STREET		OMAHA	NE	68132	04/10/2015	07/01/2015	04/15/2019	04/15/2019
Contract Detail	KOHLL'S PHARMACY & HOMECARE	12739 Q ST		OMAHA	NE	68137-3211	04/10/2015	07/01/2015	04/15/2019	04/15/2019
Contract Detail	KOHLL'S PHARMACY & HOMECARE	KOHLL'S PHARMACY & HOMECARE	622 N 114TH ST	OMAHA	NE	68154-1571	04/10/2015	07/01/2015	04/15/2019	04/15/2019
Contract Detail	KOHLL'S RX	SAKRX, LLC	12741 Q ST	OMAHA	NE	68137-3211	04/15/2019	07/01/2019		07/01/2019
Contract Detail	KOHLL'S RX	SAKRX, LLC	5002 DODGE ST	OMAHA	NE	68132-2920	04/15/2019	07/01/2019		07/01/2019
Contract Detail	KOHLL'S RX	SAKRX, LLC	5108 L ST	OMAHA	NE	68117-1330	04/15/2019	07/01/2019	04/09/2021	04/09/2021
Contract Detail	KOHLL'S RX	SAKRX, LLC	2915 LEAVENWORTH ST	OMAHA	NE	68105-2739	04/15/2019	07/01/2019		07/01/2019
Contract Detail	KOHLL/RXMPSS	5110 L ST		OMAHA	NE	68117-1330	04/10/2015	07/01/2015	04/15/2019	04/15/2019
Contract Detail	NEBRASKA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2741	6901 SOUTH 84TH STREET	LA VISTA	NE	68128	01/09/2015	04/01/2015		01/10/2017
Contract Detail	NEBRASKA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 3085	1701 GALVIN ROAD S.	BELLEVUE	NE	68005	01/09/2015	04/01/2015	09/26/2024	05/19/2025
Contract Detail	NEBRASKA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5714	4840 DODGE ST.	OMAHA	NE	68132	01/09/2015	04/01/2015		01/10/2017
Contract Detail	NEBRASKA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05863	14460 WEST MAPLE ROAD	OMAHA	NE	68116	01/09/2015	04/01/2015		01/10/2017
Contract Detail	NEBRASKA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6733	1919 N 90TH STREET	OMAHA	NE	68114	01/09/2015	04/01/2015	08/31/2023	10/08/2023
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	07/18/2016	10/01/2016		01/10/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	8940 NIEMAN ROAD	OVERLAND PARK	KS	66214-1747	07/18/2016	10/01/2016	04/16/2018	04/17/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	2604 ST. PATRICK AVENUE SUITE 2	GRAND ISLAND	NE	68803-5208	07/18/2016	10/01/2016	04/06/2017	04/11/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	4401 S. 70TH STREET SUITE 2	LINCOLN	NE	68516-3649	07/18/2016	10/01/2016	02/01/2023	05/08/2023
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	10924 JOHN GALT BLVD.	OMAHA	NE	68137-2309	07/18/2016	10/01/2016		01/10/2017
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	04/15/2019	07/01/2019	04/15/2021	04/15/2021
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/18/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	07/18/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 302, LLC	8720 S 114TH ST STE 106		LA VISTA	NE	68128-5585	04/15/2019	07/01/2019		10/15/2020
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/15/2019	07/01/2019		10/15/2020
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/17/2022	01/24/2022		01/25/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/15/2019	07/01/2019		10/15/2020
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/15/2020	07/15/2020		10/15/2020
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/10/2025	04/01/2025		04/01/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/27/2014	01/01/2015		01/10/2017
Contract Detail	SHOPKO PHARMACY #2044		FRED SQ 3020 S. 84 STREET	OMAHA	NE	68124-3215	10/27/2014	01/01/2015	11/01/2017	11/01/2017
Contract Detail	SHOPKO PHARMACY #2045	601 GALVINE ROAD SOUTH		BELLEVUE	NE	68005-2249	10/27/2014	01/01/2015	01/08/2019	01/08/2019
Contract Detail	SHOPKO PHARMACY #2046		5646 NORTH 90 STREET	OMAHA	NE	68134-1808	10/27/2014	01/01/2015	01/09/2017	01/10/2017
Contract Detail	SHOPKO PHARMACY #2047	100 SOUTH 66 STREET		LINCOLN	NE	68510-2310	10/27/2014	01/01/2015	06/08/2018	06/08/2018
Contract Detail	SHOPKO PHARMACY #2056	14445 WEST CENTER ROAD		OMAHA	NE	68144	10/27/2014	01/01/2015	01/08/2019	01/08/2019
Contract Detail	SHOPKO PHARMACY #2175	6845 SOUTH 27TH STREET		LINCOLN	NE	68512	10/27/2014	01/01/2015	06/08/2018	06/08/2018
Contract Detail	SHOPKO PHARMACY #2662	211 S 23RD ST		PLATTSMOUTH	NE	68048	07/13/2018	10/01/2018	09/26/2018	11/02/2018
Contract Detail	SHOPKO PHARMACY #2686	902 S LOCUST ST		GLENWOOD	IA	51534	10/27/2014	01/01/2015	06/08/2018	06/08/2018
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/13/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-0776	3010 EAST 23RD AVENUE NORTH		FREMONT	NE	68025	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-1326	2250 NO. DIERS AVE		GRAND ISLAND	NE	68803	01/17/2022	04/01/2022		04/01/2022
Contract Detail	WAL-MART PHARMACY 10-1637	6304 NORTH 99TH STREET		OMAHA	NE	68122	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-1671	8525 S. 71ST ST. PLAZA		PAPILLION	NE	68133	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-1683	705 SOUTH FREMONT		SHENANDOAH	IA	51601	01/09/2015	04/01/2015	04/16/2018	04/17/2018
Contract Detail	WAL-MART PHARMACY 10-1965	3201 MANAWA DRIVE		COUNCIL BLUFFS	IA	51503	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-2847	10504 SOUTH 15TH STREET		BELLEVUE	NE	68123	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-3154	2109 TOWNE CENTER DR.		BELLEVUE	NE	68123	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-3172	5051 L ST.		OMAHA	NE	68117	10/15/2017	01/01/2018		10/15/2017
Contract Detail	WAL-MART PHARMACY 10-3173	9460 GILES RD.		LA VISTA	NE	68128	04/17/2018	07/01/2018		04/17/2018
Contract Detail	WAL-MART PHARMACY 10-3267	18201 WRIGHT STREET		OMAHA (W)	NE	68130	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-4358	1606 S 72ND ST		OMAHA	NE	68124	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-5141	16960 WEST MAPLE ROAD		OMAHA(NW)	NE	68116	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/13/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-5361	12850 "L" STREET		OMAHA (SW)	NE	68137	01/09/2015	04/01/2015		01/10/2017
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/13/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02472	18040 R PLAZA	OMAHA	NE	68135	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03186	3701 N. 132ND STREET	OMAHA	NE	68164	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03202	7202 NORTH 30TH STREET	OMAHA	NE	68112	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03621	9001 BLONDO STREET	OMAHA	NE	68134-6029	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03694	1802 GALVIN ROAD SOUTH	BELLEVUE	NE	68005	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03700	535 E. BROADWAY	COUNCIL BLUFFS	IA	51503	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04405	2508 W BROADWAY	COUNCIL BLUFFS	IA	51501	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04443	9001 WEST CENTER RD.	OMAHA	NE	68124	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04754	8380 HARRISON ST	LA VISTA	NE	68128	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04772	3005 LAKE ST	OMAHA	NE	68111	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04974	5038 CENTER ST.	OMAHA	NE	68106	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05059	10725 FORT ST	OMAHA	NE	68134	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05143	7151 CASS ST	OMAHA	NE	68132	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05190	2323 L STREET	OMAHA	NE	68107	04/14/2015	07/01/2015	02/20/2025	02/24/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05306	301 W BENNETT AVE	COUNCIL BLUFFS	IA	51503	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05360	5062 S. 155TH ST.	OMAHA	NE	68137	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05540	6905 S 36TH ST	BELLEVUE	NE	68147	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05741	3001 DODGE STREET	OMAHA	NE	68131-2627	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05966	2605 S 171ST ST	OMAHA	NE	68130	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06802	15525 SPAULDING PLAZA	OMAHA	NE	68116	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06936	4310 AMES AVENUE	OMAHA	NE	68111-2149	04/14/2015	07/01/2015	11/05/2019	11/25/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06962	3121 S 24TH STREET	OMAHA	NE	68108	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07272	13155 W CENTER RD	OMAHA	NE	68144-3740	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07563	8989 W DODGE ROAD	OMAHA	NE	68114-3301	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07693	225 N SADDLE CREEK ROAD	OMAHA	NE	68131-2228	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10437	5225 N 90TH ST	OMAHA	NE	68134-2831	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11203	17909 BURKE ST.	OMAHA	NE	68118	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11204	20201 MANDERSON ST.	ELKHORN	NE	68022	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11205	6005 N. 72ND ST.	OMAHA	NE	68134	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11355	9512 S. 71ST PLAZA	PAPILLION	NE	68133	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	WALGREENS #11356	11343 S 96 ST	PAPILLION	NE	68046-4280	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13137	13510 Q STREET	OMAHA	NE	68137	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15237	2929 N. 60TH STREET	OMAHA	NE	68104	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY#16270	240 S. 77TH ST	OMAHA	NE	68114	04/14/2015	07/01/2015		01/10/2017
Contract Detail	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/14/2015	07/01/2015	10/01/2021	10/28/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/14/2015	07/01/2015		01/10/2017
Contract Detail	WALMART PHARMACY 10-3151	5018 AMES AVE		OMAHA	NE	68104	10/15/2017	01/01/2018		10/15/2017
Contract Detail	WALMART PHARMACY 10-3152	2451 N 90TH ST		OMAHA	NE	68134	04/17/2018	07/01/2018		04/17/2018
Contract Detail	WALMART PHARMACY 10-4139	360 NORTH SADDLE CREEK RD		OMAHA	NE	68131	10/15/2017	01/01/2018		10/15/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/13/2023	01/01/2024		01/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/13/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH280013AA	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - HICSA Cinic	730 S. 38th Ave	Omaha	NE	Active
DSH280013AB	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Millard-Millard Health Center	13325 Millard Ave	Omaha	NE	Active
DSH280013AC	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center Clinic - Bellevue Clinic	2510 Bellevue Medical Center Drive	Bellevue	NE	Active
DSH280013AD	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Bellevue Clinic - Immediate Care	2510 Bellevue Medical Center Drive	Bellevue	NE	Active
DSH280013AE	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Ortho Clinic	17405 Burke St.	Omaha	NE	Active
DSH280013AF	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Heart and Vascular Center	17405 Burke St.	Omaha	NE	Active
DSH280013AG	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Brentwood Clinic	8604 Giles Road	LaVista	NE	Active
DSH280013AH	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Eagle Run Clinic - Immediate Care	3685 N. 129th Street	Omaha	NE	Active
DSH280013AJ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - MRI - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013AK	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Procedure Center	111 N 175th Street	Omaha	NE	Active
DSH280013AL	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - MRI	111 N 175th Street	Omaha	NE	Terminated
DSH280013AM	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - ENT Clinic - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013AN	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Radiation Therapy	111 N 175th Street	Omaha	NE	Active
DSH280013AP	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Lab	111 N 175th Street	Omaha	NE	Active
DSH280013AQ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Ultrasound - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Terminated
DSH280013AR	Child	DSH	THE NEBRASKA MEDICAL CENTER	Elkhorn Clinic - Immediate Care Clinic	20310 Blue Sage Parkway	Omaha	NE	Terminated
DSH280013AS	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Radiology Diagnostic - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013AT	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Oral Facial Prosthetics Clinic	4014 Leavenworth Street	Omaha	NE	Active
DSH280013AU	Child	DSH	THE NEBRASKA MEDICAL CENTER	Elkhorn Clinic - Primary Care Clinic	20310 Blue Sage Parkway	Omaha	NE	Active
DSH280013AV	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICAL CENTER CLINIC - Chalco Clinic	8343 South 168th Avenue	OMAHA	NE	Active
DSH280013AW	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Radiology	111 N 175th Street	Omaha	NE	Active
DSH280013AX	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Fritch Surgery Center - Lauritzen OP Center	4014 LEAVENWORTH ST	Omaha	NE	Active
DSH280013AY	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Ortho Clinic - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013AZ	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICAL CENTER CHALCO - Immediate Care Clinic	8343 South 168th Avenue	OMAHA	NE	Active
DSH280013B	Child	DSH	THE NEBRASKA MEDICAL CENTER	UNIVERSITY HOSPITAL-CLINICAL CANCER CTR	989200 NEBRASKA MEDICAL CENTER	OMAHA	NE	Terminated
DSH280013BA	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - CT - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013BB	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Ultrasound	111 N 175th Street	Omaha	NE	Terminated
DSH280013BC	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Surgery Clinic - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013BD	Child	DSH	THE NEBRASKA MEDICAL CENTER	Lauritzen Outpatient Center - Oral Surgery Clinic - Lauritzen OP Center	4014 Leavenworth Street	Omaha	NE	Active
DSH280013BE	Child	DSH	THE NEBRASKA MEDICAL CENTER	Clarkson Family Medicine - Clinic - Clarkson Family Medicine	1319 Leavenworth St	Omaha	NE	Active
DSH280013BF	Child	DSH	THE NEBRASKA MEDICAL CENTER	Clarkson Family Medicine - Clarkson Family Medicine - ICC	1319 Leavenworth Street	Omaha	NE	Terminated
DSH280013BG	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - CT	111 N 175th Street	Omaha	NE	Terminated
DSH280013BH	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Outpatient Surgery Center	110 N 175th Street	Omaha	NE	Active
DSH280013BJ	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICAL CENTER - LOC Dermatology Clinic	4014 Leavenworth Street	Omaha	NE	Active
DSH280013BK	Child	DSH	THE NEBRASKA MEDICAL CENTER	The Nebraska Medical Center VP Int Med Rheumatology Clinic - Int Med Rheumatology Clinic	110 North 175th Street	Omaha	NE	Terminated
DSH280013BL	Child	DSH	THE NEBRASKA MEDICAL CENTER	The Nebraska Medical Center Bellevue Orthopaedics - Bellevue Ortho Clinic	2510 Bellevue Medical Center Drive	Bellevue	NE	Active
DSH280013BM	Child	DSH	THE NEBRASKA MEDICAL CENTER	The Nebraska Medical Center Twin Creek - Twin Creek Clinic	3802 Raynor Parkway	Bellevue	NE	Active
DSH280013BN	Child	DSH	THE NEBRASKA MEDICAL CENTER	Aesthetic Surgery - Aesthetic Surgery	17617 Burke Street	Omaha	NE	Terminated
DSH280013BP	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICINE INTERNAL MEDICAL - GRAND ISLAND HEALTH CENTER	729 N CUSTER AVE	GRAND ISLAND	NE	Active
DSH280013BQ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Bellevue Infusion Therapy	2500 Bellevue Medical Center Dr	Bellevue	NE	Active
DSH280013BR	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Cancer Clinic	111 N 175th Street	Omaha	NE	Active
DSH280013BS	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Facial Plastics Clinic	110 North 175th Street	Omaha	NE	Active
DSH280013BT	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Nebraska Medical Center - Village Pointe - Primary Care	110 North 175th Street	Omaha	NE	Active
DSH280013BU	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Urology	17405 BURKE ST.	Omaha	NE	Active
DSH280013BV	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Nebraska Medical Center - Clinic - Bellevue ENT	3802 Raynor Parkway	Bellevue	NE	Active
DSH280013BW	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Neurology	17405 BURKE ST.	Omaha	NE	Active
DSH280013BX	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medical Center - Village Pointe - Gastroenterology	17405 BURKE ST.	Omaha	NE	Active
DSH280013BY	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Nebraska Medical Center - Clinic - Bellevue Cardiology	2510 Bellevue Medical Center Drive	Bellevue	NE	Active
DSH280013BZ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Internal Medicine Clinic	17405 BURKE ST.	Omaha	NE	Active
DSH280013CA	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Neurophysiology	17405 BURKE ST.	Omaha	NE	Active
DSH280013CB	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Pulmonary Lab	17405 BURKE ST.	Omaha	NE	Active
DSH280013CC	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Rheumatology	110 North 175th Street	Omaha	NE	Active
DSH280013CD	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - PMED & Rehab	110 North 175th Street	Omaha	NE	Active
DSH280013CE	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Nebraska Medicine - Village Pointe - Dermatology	17405 BURKE ST.	Omaha	NE	Active
DSH280013CF	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Lauritzen Outpatient Center - Urology Clinic	4014 Leavenworth Street	Omaha	NE	Active
DSH280013CG	Child	DSH	THE NEBRASKA MEDICAL CENTER	Westroads - Clinic	10170 Nicholas St	Omaha	NE	Active
DSH280013CH	Child	DSH	THE NEBRASKA MEDICAL CENTER	Grand Island - Lab	729 N Custer Ave	Grand Island	NE	Active
DSH280013CJ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Girls Inc - Clinic	2811 N 45th St	Omaha	NE	Active
DSH280013CK	Child	DSH	THE NEBRASKA MEDICAL CENTER	Kearney - Heartland and Oncology Clinic	2232 Chancellor's Ave.	Kearney	NE	Active
DSH280013CL	Child	DSH	THE NEBRASKA MEDICAL CENTER	Oakview - DEM Clinic	2727 S. 144th Street	Omaha	NE	Active
DSH280013CM	Child	DSH	THE NEBRASKA MEDICAL CENTER	Kearney - Lab	2232 Chancellor's Ave.	Kearney	NE	Active
DSH280013CN	Child	DSH	THE NEBRASKA MEDICAL CENTER	Elkhorn - Virtual Care Clinic	20310 Blue Sage Parkway	Omaha	NE	Active
DSH280013CP	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Mammo	111 N 175th Street	Omaha	NE	Active
DSH280013CQ	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medicine - Village Pointe - Truhlsen Eye Refractive Services at Village Pointe	110 North 175th Street	Omaha	NE	Active
DSH280013CR	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICAL CENTER TRUHLSEN EYE - Refractive Services at Truhlsen Eye	3902 LEAVENWORTH ST	OMAHA	NE	Active
DSH280013CS	Child	DSH	THE NEBRASKA MEDICAL CENTER	NEBRASKA MEDICAL CENTER MIDTOWN - Midtown Immediate Care Clinic	139 S. 40TH ST.	OMAHA	NE	Active
DSH280013CT	Child	DSH	THE NEBRASKA MEDICAL CENTER	Bellevue - Multidisciplinary Clinic	2510 Bellevue Medical Center Drive	Bellevue	NE	Active
DSH280013CU	Child	DSH	THE NEBRASKA MEDICAL CENTER	Kearney - Heartland and Oncology Infusion	2232 Chancellor's Ave.	Kearney	NE	Active
DSH280013CV	Child	DSH	THE NEBRASKA MEDICAL CENTER	Village Pointe - Psychiatry	110 North 175th Street	Omaha	NE	Active
DSH280013CW	Child	DSH	THE NEBRASKA MEDICAL CENTER	Westroads - Infusion	10170 Nicholas St	Omaha	NE	Active
DSH280013CX	Child	DSH	THE NEBRASKA MEDICAL CENTER	Oakview - Diabetes Education	2727 S. 144th Street	Omaha	NE	Active
DSH280013CY	Child	DSH	THE NEBRASKA MEDICAL CENTER	Papillion - Health Center	249 Olson Dr.	Papillion	NE	Active
DSH280013D	Child	DSH	THE NEBRASKA MEDICAL CENTER	INFUSION CENTER AT VILLAGE POINTE	111 N 175th Street	OMAHA	NE	Active
DSH280013E	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Oakview - Laboratory	2727 S 144th ST.	OMAHA	NE	Active
DSH280013F	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Radiology	17405 Burke St.	OMAHA	NE	Active
DSH280013G	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - Cardiac Imaging	17405 Burke St.	OMAHA	NE	Active
DSH280013K	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center Bellevue Cancer Clinic	2510 Bellevue Medical Center Drive	BELLEVUE	NE	Active
DSH280013L	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Truhlsen Eye Institute	3902 Leavenworth St	OMAHA	NE	Active
DSH280013M	Child	DSH	THE NEBRASKA MEDICAL CENTER	SPECIALTY CARE CENTER	804 S 52nd Street	OMAHA	NE	Active
DSH280013N	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center Village Pointe - VP Eye Clinic	110 North 175th Street	Omaha	NE	Active
DSH280013P	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center Clinic - Fontenelle Clinic	5005 Ames Ave	Omaha	NE	Active
DSH280013Q	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP Plastics Clinic	17617 Burke Street	Omaha	NE	Active
DSH280013R	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP Multidisciplinary Clinic	110 North 175th Street	Omaha	NE	Terminated
DSH280013S	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP OB GYN Clinic	110 North 175th Street	Omaha	NE	Active
DSH280013T	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP ENT Clinic	110 North 175th Street	Omaha	NE	Active
DSH280013U	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP Pain Clinic	111 N 175th Street	Omaha	NE	Active
DSH280013V	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Village Pointe - VP Oral Surgery Clinic	111 N 175th Street	Omaha	NE	Active
DSH280013W	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Midtown Clinic	139 S. 40th St.	Omaha	NE	Active
DSH280013X	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Plattsmouth Clinic	1938 Highway 34 East	Plattsmouth	NE	Active
DSH280013Y	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Bellevue Clinic - Primary Care	2510 Bellevue Medical Center	Bellevue	NE	Terminated
DSH280013Z	Child	DSH	THE NEBRASKA MEDICAL CENTER	Nebraska Medical Center - Clinic - Eagle Run Clinic	3685 N. 129th Street	Omaha	NE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	Nebraska Medical Center Clinic Pharmacy 989200 Nebraska Medical Center Omaha, NE 68198-9200	The Nebraska Medical Center Clinic Pharmacy 989200 Nebraska Medical Center Omaha, NE 68198-9200	5/5/2025 6:56 AM
Addresses	Shipping Address	Update	Change Request	NEBRASKA MEDICINE KEARNEY PHARMACY 412 W 42nd STREET RM # 7 KEARNEY, NE 68845	Nebraska Medicine Kearney Pharmacy 412 W 42nd Street RM #7 Kearney, NE 68845	10/21/2024 10:10 AM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medicine Kearney Pharmacy 2232 Chancellors Ave Room 1051 Kearney, NE 68845	9/5/2024 7:37 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:52:53 PM	8/22/2024 4:29:44 PM	8/22/2024 4:29 PM
Addresses	Shipping Address	Delete	Change Request	Nebraska Medicine Westroads Clinic 10170 Nicholas St Omaha, NE 68114		7/15/2024 11:42 AM
Addresses	Shipping Address	Delete	Change Request	NEBRASKA MEDICINE GIRLS INC. HEALTH CENTER 2811 N. 45TH ST OMAHA, NE 68104		7/15/2024 11:42 AM
Contacts	Primary Contact	Update	Change Request	BARNES, BILL BUSINESS DIRECTOR, PHARMACY Nebraska Medicine 4025599537	Yochum, Kathy A Manager 340B, Contract Pharmacy 340B Program The Nebraska Medical Center 4025596320	6/11/2024 12:31 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1750130118	5/30/2024 10:57 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NE	5/30/2024 10:57 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1750130118	5/30/2024 10:57 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IA	5/30/2024 10:57 AM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medical Center Biologics Production Facility 4215 Emile Street Omaha, NE 68198	12/27/2023 9:29 AM
Addresses	Shipping Address	Insert	Change Request		NEBRASKA MEDICINE HOME INFUSION PHARMACY 12565 W Center RD STE 120 Omaha, NE 68144	11/14/2023 12:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1770266546	11/14/2023 12:14 PM
Medicaid Billing	NPI: State	Insert	Change Request		NE	11/14/2023 12:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1770266546	11/14/2023 12:14 PM
Medicaid Billing	NPI: State	Insert	Change Request		IA	11/14/2023 12:14 PM
Addresses	Shipping Address	Delete	Recertification	LAURITZEN OUTPATIENT CENTER 4014 LEAVENWORTH STREET OMAHA, NE 68105		9/5/2023 10:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477264596	9/5/2023 10:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/5/2023 10:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477264596	9/5/2023 10:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/5/2023 10:52 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 12:15:42 PM	9/5/2023 10:52:53 PM	9/5/2023 10:52 PM
Addresses	Shipping Address	Delete	Change Request	BUFFETT CANCER CENTER 986828 NEBRASKA MEDICAL CENTER OMAHA, NE 68198-6828		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Clarkson Doctors Building South 4239 Farnam Street Omaha, NE 68131		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Clarkson Doctors Building North 4242 Farnam Street Omaha, NE 68131		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Durham Outpatient Center 4400 Emile Street Omaha, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	LIED TRANSPLANT TOWER 4315 Emile Street Omaha, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Specialty Services Pavilion 4350 Emile Street Omah, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Clarkson Tower 4350 Dewey Ave Omaha, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Hixson-Lied Center 4378 Dewey Ave Omaha, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	University Tower 4400 Emile Street Omaha, NE 68105		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	Nebraska Medicine Internal Medical Associates 729 North Custer Ave. Grand Island, NE 68803		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	The Nebraska Medical Center 984125 Nebraska Medical Center Omaha, NE 68198-4125		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	The Nebraska Medical Center 983331 Nebraska Medical Center Omaha, NE 68198-3331		7/14/2023 2:11 PM
Addresses	Shipping Address	Delete	Change Request	The Nebraska Medical Center 984110 Nebraska Medical Center Omaha, NE 68198-4110		7/14/2023 2:11 PM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medical Center Clinic Pharmacy 989200 Nebraska Medical Center Omaha, NE 68198-9200	7/14/2023 2:11 PM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medicine Pharmacy at Lauritzen Outpatient Center 4014 Leavenworth St Omaha, NE 68198	7/14/2023 2:11 PM
Addresses	Shipping Address	Insert	Change Request		NEBRASKA MEDICINE VILLAGE POINTE PHARMACY 17405 Burke ST STE 0026 Omaha, NE 68118	2/23/2023 2:46 PM
Addresses	Shipping Address	Insert	Change Request		NEBRASKA MEDICINE KEARNEY PHARMACY 412 W 42nd STREET RM # 7 KEARNEY, NE 68845	12/6/2022 6:44 AM
Addresses	Shipping Address	Insert	Change Request		NEBRASKA MEDICINE GIRLS INC. HEALTH CENTER 2811 N. 45TH ST OMAHA, NE 68104	10/3/2022 7:03 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0507459 (IA)		9/8/2022 12:15 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0507418 (IA)		9/8/2022 12:15 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	911858433-11 (NE)		9/8/2022 12:15 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	911858433-02 (NE)		9/8/2022 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972247799	9/8/2022 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/8/2022 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285394049	9/8/2022 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/8/2022 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972247799	9/8/2022 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/8/2022 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285394049	9/8/2022 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/8/2022 12:15 PM
Details	Last Recertification Date	Update	Recertification	9/2/2021 11:13:56 AM	9/8/2022 12:15:42 PM	9/8/2022 12:15 PM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medicine Westroads Clinic 10170 Nicholas St Omaha, NE 68114	8/18/2022 2:04 PM
Addresses	Shipping Address	Insert	Change Request		NEBRASKA MEDICINE HUB PHARMACY 770 N 114TH ST OMAHA, NE 68154-1572	8/9/2022 9:02 AM
Addresses	Shipping Address	Delete	Recertification	LAURITZEN OUTPATIENT CENTER 4014 LEAVENWORTH STREET OMAHA, NE 68198		9/2/2021 11:13 AM
Addresses	Shipping Address	Insert	Recertification		LAURITZEN OUTPATIENT CENTER 4014 LEAVENWORTH STREET OMAHA, NE 68105	9/2/2021 11:13 AM
Details	Last Recertification Date	Update	Recertification	8/27/2020 2:38:28 PM	9/2/2021 11:13:56 AM	9/2/2021 11:13 AM
Addresses	Shipping Address	Insert	Recertification		The Nebraska Medical Center 984125 Nebraska Medical Center Omaha, NE 68198-4125	8/27/2020 2:38 PM
Addresses	Shipping Address	Insert	Recertification		The Nebraska Medical Center 983331 Nebraska Medical Center Omaha, NE 68198-3331	8/27/2020 2:38 PM
Addresses	Shipping Address	Insert	Recertification		The Nebraska Medical Center 984110 Nebraska Medical Center Omaha, NE 68198-4110	8/27/2020 2:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1356307581	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/27/2020 2:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467529727	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/27/2020 2:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780135319	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/27/2020 2:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1942368352	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Update	Recertification		NE	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Update	Recertification		NE	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Update	Recertification		NE	8/27/2020 2:38 PM
Medicaid Billing	NPI: State	Update	Recertification		NE	8/27/2020 2:38 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 11:44:13 AM	8/27/2020 2:38:28 PM	8/27/2020 2:38 PM
Addresses	Shipping Address	Insert	Change Request		Nebraska Medicine Internal Medical Associates 729 North Custer Ave. Grand Island, NE 68803	7/13/2020 5:09 PM
Details	Last Recertification Date	Update	Recertification	9/5/2018 10:51:47 AM	8/21/2019 11:44:13 AM	8/21/2019 11:44 AM
Addresses	Main Address	Update	Change Request	989020 Nebraska Medical Center Omaha, NE 68198	989200 Nebraska Medical Center Omaha, NE 68198	7/9/2019 11:36 AM
Addresses	Main Address	Update	Change Request	981090 Nebraska Medical Center Omaha, NE 68198	989020 Nebraska Medical Center Omaha, NE 68198	6/24/2019 4:43 PM
Addresses	Main Address	Update	Change Request	989200 NEBRASKA MEDICAL CENTER OMAHA, NE 68198	981090 Nebraska Medical Center Omaha, NE 68198	5/23/2019 9:27 AM
Addresses	Shipping Address	Insert	Change Request		The Nebraska Medical Center 987400 Nebraska Medical Center Omaha, NE 68198	5/23/2019 9:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/29/2019 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		91185843326	1/29/2019 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	1/29/2019 2:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10025581200 (NE)		1/29/2019 2:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10025727800 (NE)		1/29/2019 2:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	282N00000X (IA)		1/29/2019 2:17 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1467529727	1/29/2019 2:17 PM
Addresses	Shipping Address	Insert	Change Request		THE NEBRASKA MEDICAL CENTER BELLEVUE PHARMACY 2510 BELLEVUE MEDICAL CENTER DR SUITE 100 BELLEVUE, NE 68123	12/13/2018 2:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/13/2018 9:53 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0507459	11/13/2018 9:53 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	11/13/2018 9:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/13/2018 9:53 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0507418	11/13/2018 9:53 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	11/13/2018 9:53 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1356307581	11/13/2018 9:53 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 4:25:39 PM	9/5/2018 10:51:47 AM	9/5/2018 10:51 AM
Addresses	Shipping Address	Insert	Change Request		LIED TRANSPLANT TOWER 4315 Emile Street Omaha, NE 68105	7/18/2018 2:54 PM
Addresses	Shipping Address	Insert	Change Request		Specialty Services Pavilion 4350 Emile Street Omah, NE 68105	7/18/2018 2:54 PM
Addresses	Shipping Address	Insert	Change Request		Clarkson Tower 4350 Dewey Ave Omaha, NE 68105	7/18/2018 2:54 PM
Addresses	Shipping Address	Insert	Change Request		Hixson-Lied Center 4378 Dewey Ave Omaha, NE 68105	7/18/2018 2:54 PM
Addresses	Shipping Address	Insert	Change Request		University Tower 4400 Emile Street Omaha, NE 68105	7/18/2018 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/5/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		282N00000X	4/5/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	4/5/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/5/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		911858433-11	4/5/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	4/5/2018 8:30 AM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	12/1/2017 4:25:39 PM	12/1/2017 4:25 PM
Addresses	Shipping Address	Insert	Change Request		Clarkson Doctors Building South 4239 Farnam Street Omaha, NE 68131	10/10/2017 10:31 AM
Addresses	Shipping Address	Insert	Change Request		Clarkson Doctors Building North 4242 Farnam Street Omaha, NE 68131	10/10/2017 10:31 AM
Addresses	Shipping Address	Insert	Change Request		Durham Outpatient Center 4400 Emile Street Omaha, NE 68105	10/10/2017 10:31 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	4704912 (NE)		10/10/2017 10:31 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	47049123301 (NE)		10/10/2017 10:31 AM
Contacts	Authorizing Official	Update	New Registration	Daubert, Stephanie CFO 4025522889	Daubert, Stephanie CFO Nebraska Medical Center 4025522889	10/9/2017 1:58 PM
Contacts	Primary Contact	Update		BARNES, BILL BUSINESS DIRECTOR, PHARMACY 4025599537	BARNES, BILL BUSINESS DIRECTOR, PHARMACY Nebraska Medicine 4025599537	9/29/2017 8:48 AM
Contacts	Authorizing Official	Insert			Daubert, Stephanie CFO 4025522889	8/12/2017 1:53 PM
Addresses	Main Address	Insert			989200 NEBRASKA MEDICAL CENTER OMAHA, NE 68198	8/1/2017 9:15 AM
Addresses	Shipping Address	Insert			UNIVERSITY OF NEBRASKA MEDICAL CENTER 4401 DEWEY AVE. OMAHA, NE 68198	8/1/2017 9:15 AM
Addresses	Shipping Address	Insert			UNIVERSITY HOSPITAL PHARMACY 981090 NEBRASKA MEDICAL CENTER OMAHA, NE 68198	8/1/2017 9:15 AM
Addresses	Shipping Address	Insert			LAURITZEN OUTPATIENT CENTER 4014 LEAVENWORTH STREET OMAHA, NE 68198	8/1/2017 9:15 AM
Addresses	Shipping Address	Insert			BUFFETT CANCER CENTER 986828 NEBRASKA MEDICAL CENTER OMAHA, NE 68198-6828	8/1/2017 9:15 AM
Contacts	Primary Contact	Insert			BARNES, BILL BUSINESS DIRECTOR, PHARMACY 4025599537	8/1/2017 9:15 AM
Medicaid Billing	NPI: Number	Insert			1780135319	1/10/2017 9:57 AM
Details	Last Recertification Date	Update		8/18/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 4:47 PM
Medicaid Billing	NPI: Number	Insert			1942368352	1/15/2016 11:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: Number	Insert			10025581200	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: State	Insert			NE	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: Number	Insert			10025727800	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: State	Insert			NE	8/18/2015 11:27 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/18/2015 11:27 AM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/18/2015 12:00:00 AM	8/18/2015 11:27 AM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:21 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/30/2013 12:00:00 AM	8/30/2013 12:10 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:37 AM
Details	Last Recertification Date	Insert				12/16/2010 2:51 PM
Details	Grant Number	Insert				12/16/2010 2:51 PM
Details	340B ID	Insert			DSH280013	12/16/2010 2:51 PM
Details	Is Authorizing Official EHB Data	Insert				12/16/2010 2:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/16/2010 2:51 PM
Details	Medicare Provider Number	Insert			280013	12/16/2010 2:51 PM
Details	Entity Name	Insert			THE NEBRASKA MEDICAL CENTER	12/16/2010 2:51 PM
Details	Program Code	Insert			DSH	12/16/2010 2:51 PM
Details	Entity Subname	Insert				12/16/2010 2:51 PM
Dates	Participating Approval Date	Insert			9/10/2007 12:00:00 AM	12/16/2010 2:51 PM
Details	State	Insert			Active	12/16/2010 2:51 PM
Dates	Registration Date	Insert			9/8/2007 12:00:00 AM	12/16/2010 2:51 PM
Dates	Signed By Date	Insert				12/16/2010 2:51 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	12/16/2010 2:51 PM
Terminations	Termination Comments	Insert				12/16/2010 2:51 PM
Terminations	Termination Date	Insert				12/16/2010 2:51 PM
Terminations	Termination Effective Date	Insert				12/16/2010 2:51 PM
Terminations	Termination Reason	Insert				12/16/2010 2:51 PM
Details	Comments Public	Insert			12/10/09 ADDED SHIP TO; 10/8/09 UPDATED ENTITY NAME (WAS UNIVERSITY OF NEBRASKA MEDICAL CENTER); 9/25/09 UPDATED ADDR (WAS 4401 DEWEY AVE); 9/25/09 ADDED SHIP TO 12/16/10ADDED MEDICAID#911858433-02	12/16/2010 2:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: Number	Insert			4704912	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: State	Insert			NE	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: Number	Insert			47049123301	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: State	Insert			NE	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: Number	Insert			911858433-02	9/8/2007 2:12 PM
Medicaid Billing	Medicaid: State	Insert			NE	9/8/2007 2:12 PM