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WELLNESS PHARMACY, INC
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
WELLNESS PHARMACY, INC
Pharmacy Address
4640 CHAMPLAIN DR STE 113
LINCOLN, NE 68521
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
4/7/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donna Manstedt, Clinic Manager
(402) 434-7177 Ext: 317
Contract Pharmacy Representative
Wellness Pharmacy of Lincoln
Kayla Pham, Pharm.D
(402) 413-9950
Signed By Date
4/7/2020
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