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EMERSON APOTHECARY
CAH281349-00 PENDER COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PENDER COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281349-00
Entity Address
100 HOSPITAL DR
PENDER, NE 68047-0100
Medicare Provider Number
281349
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
EMERSON APOTHECARY
Pharmacy Address
1003 S MAIN ST STE 2
EMERSON, NE 68733-3613
Pharmacy Comments
Contract Details
Approval Date
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa Kelly, CFO/COO
(402) 385-4012
Contract Pharmacy Representative
Pender Community Hospital - Apothecary Shop
Shane Michael Schuster, Pharmacist
(402) 385-3350
Signed By Date
4/2/2019
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