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OMNICARE OF NEBRASKA
CAH161323-00 Mitchell County Regional Health Center
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Covered Entity Details
Entity Name
Mitchell County Regional Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161323-00
Entity Address
616 N. 8TH STREET
OSAGE, IA 50461
Medicare Provider Number
161323
Participating Start Date
1/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OMNICARE OF NEBRASKA
Pharmacy Address
8402 S 117TH ST SUITES 300,400
LA VISTA, NE 68128
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory J. Burkel, EXECUTIVE FINANCE OFFICER
(641) 732-6070
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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