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NEBRASKA CVS PHARMACY, L.L.C.
DSH160058 UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160058
Entity Address
200 HAWKINS DRIVE
IOWA CITY, IA 52242
Medicare Provider Number
160058
Participating Start Date
10/1/1999
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NEBRASKA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08294
4808 O STREET
LINCOLN, NE 68510
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/20/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2021
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