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CAH281345-00 Providence Medical Center (Active)
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Main Details
Name
Providence Medical Center
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH281345-00
Medicare Provider Number
281345
Additional Details
Current Program Status
Active
Registration Date
8/28/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/11/2012
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Providence Medical Center
Nicole Haglund, Interim CEO
(402) 375-3800
Primary Contact
Providence Medical Center
Kimberly Lueders, Pharmacy Director
(402) 375-7920
Addresses
Street Address
1200 Providence Rd
Wayne, NE 68787
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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