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ST JOSEPH'S MCAULEY PHARMACY
DSH280060 Alegent Health Bergan Mercy Health System d/b/a CHI Health Creighton University Med Center-Bergan Mercy
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Covered Entity Details
Entity Name
Alegent Health Bergan Mercy Health System d/b/a CHI Health Creighton University Med Center-Bergan Mercy
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH280060
Entity Address
7500 Mercy Road
Omaha, NE 68124
Medicare Provider Number
280060
Participating Start Date
1/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
500 W. THOMAS ROAD
SUITE 190
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/16/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Joseph Nokels, President
(402) 818-2050
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/16/2019
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