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CHI HEALTH PHARMACY - BERGAN MERCY
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
CHI HEALTH PHARMACY - BERGAN MERCY
Pharmacy Address
7710 MERCY RD STE 110
OMAHA, NE 68124-2346
Pharmacy Comments
Contract Details
Approval Date
10/25/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARIE KNEDLER, President
(712) 328-5067
Contract Pharmacy Representative
CHI Health
Gregory Schardt, Division Director of Pharmacy Operations
(402) 206-3370
Signed By Date
10/25/2019
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