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CHI HEALTH PHARMACY - LAKESIDE
DSH160028 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
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Covered Entity Details
Entity Name
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160028
Entity Address
800 MERCY DRIVE
COUNCIL BLUFFS, IA 51503
Medicare Provider Number
160028
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CHI HEALTH PHARMACY - LAKESIDE
Pharmacy Address
16909 LAKESIDE HILLS CT STE 107
OMAHA, NE 68130-4661
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/11/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nick O'Tool, Division VP Finance
(402) 717-8118
Contract Pharmacy Representative
CHI Health
Gregory Schardt, Division Director of Pharmacy Operations
(402) 206-3370
Signed By Date
10/16/2019
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