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SAFEWAY INC
CAH281355-00 OGALLALA COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
OGALLALA COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281355-00
Entity Address
2601 North Spruce Street
Ogallala, NE 69153
Medicare Provider Number
281355
Participating Start Date
9/28/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #0557
611 NORTH SPRUCE STREET
OGALLALA, NE 69153
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/27/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263
Contract Pharmacy Representative
SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304
Signed By Date
4/15/2019
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