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DSH280081 CHI Health Immanuel (Active)
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Main Details
Name
CHI Health Immanuel
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH280081
Medicare Provider Number
280081
Additional Details
Current Program Status
Active
Registration Date
10/30/2007
Participating Start Date
4/1/2005
Participating Approval Date
10/30/2007
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
6901 N. 72ND ST
OMAHA, NE 68122
Billing Address
CHI Health Immanuel
ATTN: 2210-5100112
PO Box 636000
Littleton, CO 80163
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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