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DSH280013Y THE NEBRASKA MEDICAL CENTER (Terminated)
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Main Details
Name
THE NEBRASKA MEDICAL CENTER
Subdivision Name
Nebraska Medical Center - Clinic - Bellevue Clinic - Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH280013Y
Medicare Provider Number
280013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/30/2017
Last Recertification Date
8/25/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Nebraska Medical Center
Stephanie Daubert, CFO
(402) 552-2889
Primary Contact
The Nebraska Medical Center
Randy Alan Moore, Clinical Pharmacy Manager Outpatient Specialty Pharmacy
(402) 559-1238
Addresses
Street Address
2510 Bellevue Medical Center
250
Bellevue, NE 68123
Billing Address
Nebraska Medical Center
989200 Nebraska Medical Center
Omaha, NE 68198
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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