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HY-VEE PHARMACY (1221)
DSH280013 THE NEBRASKA MEDICAL CENTER
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Covered Entity Details
Entity Name
THE NEBRASKA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH280013
Entity Address
989200 Nebraska Medical Center
Omaha, NE 68198
Medicare Provider Number
280013
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1221)
Pharmacy Address
115 WILMAR AVE
GRAND ISLAND, NE 68803
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie Daubert, CFO
(402) 552-2889
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/7/2020
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