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HENDERSON PHARMACY LLC
CAH281308-00 HENDERSON HEALTH CARE SERVICES
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Covered Entity Details
Entity Name
HENDERSON HEALTH CARE SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281308-00
Entity Address
1621 FRONT ST.
HENDERSON, NE 68371
Medicare Provider Number
281308
Participating Start Date
10/1/2014
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HENDERSON PHARMACY LLC
Pharmacy Address
1060 N MAIN ST
PO BOX 711
HENDERSON, NE 68371
Pharmacy Comments
Contract Details
Approval Date
3/30/2022
Contract Begin Date
3/30/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheryl Brown, CEO
(402) 723-4512 Ext: 4014
Contract Pharmacy Representative
HENDERSON PHARMACY LLC
RANDY GLEN BALDWIN, PHARMACIST
(402) 723-4475
Signed By Date
3/30/2022
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