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WAL-MART PHARMACY 10-3278
CH078170 Bluestem Health
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Covered Entity Details
Entity Name
Bluestem Health
Subdivision Name
Bluestem Health
Type
HRSA-Funded Health Center
340B ID
CH078170
Entity Address
1021 N 27th St
Lincoln, NE 68503-1803
Grant Number
H80CS00236
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3278
Pharmacy Address
8700 ANDERMATT DR
LINCOLN, NE 68526
Pharmacy Comments
Contract Details
Approval Date
1/2/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brad Lee Meyer, Chief Executive Officer
(402) 470-5424
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/2/2017
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