340B Drug Pricing Program Database
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CAH281328-00 MERRICK MEDICAL CENTER (Active)
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Main Details
Name
MERRICK MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH281328-00
Medicare Provider Number
281328
Additional Details
Current Program Status
Active
Registration Date
11/24/2010
Participating Start Date
1/1/2014
Participating Approval Date
12/16/2010
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Merrick Medical Center
Jodi Mohr, President/CEO
(308) 946-3015
Primary Contact
Merrick Medical Center
Allyn Komorowski, Pharmacy Manager
(308) 946-5981
Addresses
Street Address
2802 28th Street
CENTRAL CITY, NE 68826
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/15/13 participating 1/1/11 thru 3/31/12, not participating 4/1/12 thru 12/31/13 due to termination at request of covered entity, reinstated based on on-line registration submitted in Oct. 2013
11/15/2013
April 2025
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