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KOHLL'S RX
URB7944A Nebraska Urban Indian Health Coalition Inc
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Covered Entity Details
Entity Name
Nebraska Urban Indian Health Coalition Inc
Subdivision Name
Nebraska Urban Indian Medical Center
Type
Urban Indian
340B ID
URB7944A
Entity Address
2331 Fairfield Street Suite 1
Lincoln, NE 68521-1348
Grant Number
Participating Start Date
1/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KOHLL'S RX
Pharmacy Address
SAKRX, LLC
808 N 27TH ST
LINCOLN, NE 68503-2523
Pharmacy Comments
Contract Details
Approval Date
12/6/2019
Contract Begin Date
12/6/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donna Manstedt, Clinic Manager
(402) 434-7177 Ext: 317
Contract Pharmacy Representative
Kholls Rx
Bryce Walker, 340B Coordinator
(402) 476-3341
Signed By Date
12/6/2019
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