Contract Pharmacy Details

TOM'S REXALL DRUG
CAH281349-00 PENDER COMMUNITY HOSPITAL

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

TOM'S REXALL DRUG

Pharmacy Address

124 N MAIN ST
WEST POINT, NE 68788-1416

Pharmacy Comments

Contract Details

Approval Date

10/8/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/28/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Melissa Kelly, CFO/COO
(402) 385-4012

Contract Pharmacy Representative

Tom's
Jon Einfalt, Owner
(402) 372-2108

Signed By Date

10/8/2019