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NEBRASKA CVS PHARMACY, L.L.C.
SCH260006-00 HEARTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HEARTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260006-00
Entity Address
5325 FARAON
ST. JOSEPH, MO 64506-3398
Medicare Provider Number
260006
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
NEBRASKA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08626
7002 O STREET
LINCOLN, NE 68510
Pharmacy Comments
Contract Details
Approval Date
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dwain Stilson, Chief Financial Officer
(816) 271-7070
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2020
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