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ST JOSEPH'S MCAULEY PHARMACY
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
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
500 W. THOMAS ROAD
SUITE 190
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
7/1/2019
Contract Begin Date
10/1/2019
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
TIM SCHNACK, CFO
(402) 572-3701
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
7/1/2019
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