Contract Pharmacy Details

KOHLL'S RX
DSH280013 THE NEBRASKA MEDICAL CENTER

Covered Entity Details

Entity Name

THE NEBRASKA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH280013

Entity Address

989200 Nebraska Medical Center
Omaha, NE 68198

Medicare Provider Number

280013

Participating Start Date

12/1/1992

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

KOHLL'S RX

Pharmacy Address

SAKRX, LLC
2915 LEAVENWORTH ST
OMAHA, NE 68105-2739

Pharmacy Comments

Contract Details

Approval Date

4/15/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephanie Daubert, CFO
(402) 552-2889

Contract Pharmacy Representative

Kohll's RX
David Kohll, President
(402) 895-6812

Signed By Date

4/15/2019