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WALGREEN CO.
DSH280081 CHI Health Immanuel
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Covered Entity Details
Entity Name
CHI Health Immanuel
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH280081
Entity Address
6901 N. 72ND ST
OMAHA, NE 68122
Medicare Provider Number
280081
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06936
4310 AMES AVENUE
OMAHA, NE 68111-2149
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIM SCHNACK, CFO
(402) 572-3701
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2018
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