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WAHOO MAN LLC DBA MEDICINE MAN PHARMACY
CAH281307-00 Saunders Medical Center
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Covered Entity Details
Entity Name
Saunders Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281307-00
Entity Address
1760 COUNTY ROAD "J"
WAHOO, NE 68066
Medicare Provider Number
281307
Participating Start Date
4/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAHOO MAN LLC DBA MEDICINE MAN PHARMACY
Pharmacy Address
526 N LINDEN ST
WAHOO, NE 68066
Pharmacy Comments
Contract Details
Approval Date
8/5/2021
Contract Begin Date
8/5/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie Rezac, CEO
(402) 443-4191 Ext: 343
Contract Pharmacy Representative
Medicine Man Pharmacy
Mitch Staiger, Owner
(402) 652-3217
Signed By Date
8/5/2021
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