Covered Entity Details

DSH160028 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs (Active) - information as of 6/24/2025 3:02:50 AM

Main Details

Name

ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH160028

Medicare Provider Number

160028

Additional Details

Current Program Status

Active

Registration Date

10/18/2007

Participating Start Date

4/1/2005

Participating Approval Date

10/18/2007

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

CHI Health
Nick O'Tool, Division VP Finance
(402) 717-8118

Primary Contact

CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620

Addresses

Street Address

800 MERCY DRIVE
COUNCIL BLUFFS, IA 51503

Billing Address

ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
ATTN: 2210-5100111
PO Box 636000
Littleton, CO 80163

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
2/16/12 remove medicaid #	02/16/2012

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
IA	060028S	1265517759,1437384799
NE	47048476410,47048476420	1265517759,1437384799

Shipping Addresses

Shipping Address 1

ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
800 MERCY DRIVE
COUNCIL BLUFFS, IA 51503

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CHI HEALTH PHARMACY - 132ND AND CENTER	13315 W CENTER RD STE 101		OMAHA	NE	68144	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - 161ST AND MAPLE	16101 EVANS ST	SUITE 101	OMAHA	NE	68116-6447	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - 42ND AND L	4220 L ST		OMAHA	NE	68107	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - BELLEVUE	3308 SAMSON WAY STE 106A		BELLEVUE	NE	68123	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - BERGAN MERCY	7710 MERCY RD STE 110		OMAHA	NE	68124-2346	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - FLORENCE	8613 N 30TH ST		OMAHA	NE	68112-1852	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - IMMANUEL	6829 N 72ND ST STE 2160		OMAHA	NE	68122	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - LAKESIDE	16909 LAKESIDE HILLS CT STE 107		OMAHA	NE	68130-4661	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - LAVISTA	8248 S 96TH ST STE 101		LA VISTA	NE	68128	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY - MIDLANDS	11109 S. 84TH ST. STE 1841		PAPILLION	NE	68046	10/16/2019	01/01/2020	06/01/2025	06/04/2025
Contract Detail	CHI HEALTH PHARMACY - VALLEY VIEW	1288 VALLEY VIEW DRIVE	SUITE 101	COUNCIL BLUFFS	IA	51503-5245	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH PHARMACY WEST BROADWAY	3135 W BROADWAY	SUITE 101	COUNCIL BLUFFS	IA	51501	10/16/2019	01/01/2020	08/11/2022	08/15/2022
Contract Detail	CHI HEALTH SPECIALTY PHARMACY	7710 MERCY RD STE 102		OMAHA	NE	68124-2339	04/12/2019	07/01/2019	09/22/2021	08/15/2022
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	HY-VEE DRUGSTORE PHARMACY #7030	757 W. BROADWAY		COUNCIL BLUFFS	IA	51501	03/10/2011	03/10/2011	12/31/2016	01/14/2017
Contract Detail	HY-VEE PHARMACY #1101	10 HY-VEE DRIVE		COUNCIL BLUFFS	IA	51503	03/10/2011	03/10/2011	12/31/2016	01/14/2017
Contract Detail	HY-VEE PHARMACY (1092)	HY VEE INC	2323 WEST BROADWAY	COUNCIL BLUFFS	IA	51501	03/10/2011	03/10/2011	12/31/2016	01/14/2017
Contract Detail	HY-VEE PHARMACY FULFILLMENT CENTER 4016	HY-VEE INC	4707 FLUER DR	DES MOINES	IA	50321	10/28/2013	01/01/2014	08/01/2016	08/02/2016
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	ST JOSEPH'S MCAULEY PHARMACY	500 W. THOMAS ROAD	SUITE 190	PHOENIX	AZ	85013	04/15/2019	07/01/2019	04/30/2021	10/22/2021
Contract Detail	SUPER SAVER PHARMACY #12	1141 N BROADWAY		COUNCIL BLUFFS	IA	51503	03/20/2012	03/20/2012	12/31/2016	01/14/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06962	3121 S 24TH STREET	OMAHA	NE	68108	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03700	535 E. BROADWAY	COUNCIL BLUFFS	IA	51503	07/17/2018	10/01/2018	06/01/2025	06/04/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05306	301 W BENNETT AVE	COUNCIL BLUFFS	IA	51503	07/17/2018	10/01/2018	06/01/2025	06/04/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05190	2323 L STREET	OMAHA	NE	68107	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05540	6905 S 36TH ST	BELLEVUE	NE	68147	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04405	2508 W BROADWAY	COUNCIL BLUFFS	IA	51501	07/17/2018	10/01/2018	06/01/2025	06/04/2025
Contract Detail	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	07/14/2023	10/01/2023	06/01/2025	06/04/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/17/2018	10/01/2018	07/06/2022	07/07/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/17/2018	10/01/2018	07/06/2022	07/07/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:12:40 AM	8/19/2024 2:04:03 PM	8/19/2024 2:04 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Regional Manager CommonSpirit Health - Central Region 7019280620	8/6/2024 1:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	9/27/2023 5:22 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:23:14 PM	8/17/2023 10:12:40 AM	8/17/2023 10:12 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 11:38:24 AM	9/6/2022 12:23:14 PM	9/6/2022 12:23 PM
Contacts	Authorizing Official	Update	Profile Change Request	O'Tool, Nick Duane Vice President Operational Finance CHI Health 4027178118	O'Tool, Nick Division VP Finance CHI Health 4027178118	6/2/2022 11:06 AM
Addresses	Billing Address	Insert	Change Request		ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs ATTN: 2210-5100111 PO Box 636000 Littleton, CO 80163	5/25/2022 2:49 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh CHI St. Alexius Health Carrington 7019280620	Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	3/10/2022 3:00 PM
Contacts	Primary Contact	Update	Change Request	McKeown, Laura Rose Director Pharmacy CHI Health Mercy Council Bluffs 7123285094	Schultz, Mitchell RPh CHI St. Alexius Health Carrington 7019280620	2/15/2022 2:35 PM
Contacts	Primary Contact	Update	Change Request	ZADINA, MICHAEL DIRECTOR OF PHARMACY CHI Health Mercy Council Bluffs 7123285094	McKeown, Laura Rose Director Pharmacy CHI Health Mercy Council Bluffs 7123285094	9/16/2021 12:44 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 7:49:21 AM	8/16/2021 11:38:24 AM	8/16/2021 11:38 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1265517759	8/19/2020 7:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/19/2020 7:49 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1437384799	8/19/2020 7:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/19/2020 7:49 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1265517759	8/19/2020 7:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	8/19/2020 7:49 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1437384799	8/19/2020 7:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	8/19/2020 7:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265517759 ( )		8/19/2020 7:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437384799 ( )		8/19/2020 7:49 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:25:01 AM	8/19/2020 7:49:21 AM	8/19/2020 7:49 AM
Addresses	Shipping Address	Delete	Recertification	SAFECOR HEALTH, LLC 4060 BUSINESS PARK DRIVE COLUMBUS, OH 43204		8/28/2019 9:25 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 11:33:50 AM	8/28/2019 9:25:01 AM	8/28/2019 9:25 AM
Contacts	Authorizing Official	Update	AO Change Request	KNEDLER, MARIE President CHI Health Mercy 7123285067	O'Tool, Nick Duane Vice President Operational Finance CHI Health 4027178118	3/13/2019 6:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		060028S	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		47048476410	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		47048476420	9/12/2018 9:31 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	9/12/2018 9:31 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1265517759	9/12/2018 9:31 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1437384799	9/12/2018 9:31 AM
Details	Last Recertification Date	Update	Recertification	12/5/2017 2:39:10 PM	8/22/2018 11:33:50 AM	8/22/2018 11:33 AM
Addresses	Shipping Address	Insert	Recertification		SAFECOR HEALTH, LLC 4060 BUSINESS PARK DRIVE COLUMBUS, OH 43204	12/5/2017 2:39 PM
Addresses	Shipping Address	Insert	Recertification		ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs 800 MERCY DRIVE COUNCIL BLUFFS, IA 51503	12/5/2017 2:39 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	12/5/2017 2:39:10 PM	12/5/2017 2:39 PM
Contacts	Authorizing Official	Update		KNEDLER, MARIE President 7123285067	KNEDLER, MARIE President CHI Health Mercy 7123285067	10/16/2017 3:30 PM
Contacts	Primary Contact	Update		ZADINA, MICHAEL DIRECTOR OF PHARMACY 7123285094	ZADINA, MICHAEL DIRECTOR OF PHARMACY CHI Health Mercy Council Bluffs 7123285094	9/19/2017 11:24 AM
Addresses	Main Address	Insert			800 MERCY DRIVE COUNCIL BLUFFS, IA 51503	8/16/2016 3:43 PM
Contacts	Authorizing Official	Insert			KNEDLER, MARIE President 7123285067	8/16/2016 3:43 PM
Contacts	Primary Contact	Insert			ZADINA, MICHAEL DIRECTOR OF PHARMACY 7123285094	8/16/2016 3:43 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 3:43 PM
Details	Last Recertification Date	Update		8/18/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 9:43 AM
Details	Entity Name	Update		ALEGENT HEALTH - MERCY HOSPITAL COUNCIL BLUFFS	ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs	12/2/2014 7:16 AM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	8/18/2014 12:00:00 AM	8/18/2014 2:21 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 12:00:00 AM	9/5/2013 6:27 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 7:39 AM
Details	Comments Public	Insert			2/16/12 remove medicaid #	2/16/2012 8:33 AM
Details	Last Recertification Date	Insert				9/5/2008 10:33 AM
Details	Grant Number	Insert				9/5/2008 10:33 AM
Details	340B ID	Insert			DSH160028	9/5/2008 10:33 AM
Details	Is Authorizing Official EHB Data	Insert				9/5/2008 10:33 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/5/2008 10:33 AM
Details	Medicare Provider Number	Insert			160028	9/5/2008 10:33 AM
Details	Entity Name	Insert			ALEGENT HEALTH - MERCY HOSPITAL COUNCIL BLUFFS	9/5/2008 10:33 AM
Details	Program Code	Insert			DSH	9/5/2008 10:33 AM
Details	Entity Subname	Insert				9/5/2008 10:33 AM
Dates	Participating Approval Date	Insert			10/18/2007 12:00:00 AM	9/5/2008 10:33 AM
Details	State	Insert			Active	9/5/2008 10:33 AM
Dates	Registration Date	Insert			10/18/2007 12:00:00 AM	9/5/2008 10:33 AM
Dates	Signed By Date	Insert				9/5/2008 10:33 AM
Dates	Start Date	Insert			4/1/2005 12:00:00 AM	9/5/2008 10:33 AM
Terminations	Termination Comments	Insert				9/5/2008 10:33 AM
Terminations	Termination Date	Insert				9/5/2008 10:33 AM
Terminations	Termination Effective Date	Insert				9/5/2008 10:33 AM
Terminations	Termination Reason	Insert				9/5/2008 10:33 AM