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BLOOD PHARMACY TILDEN
CAH281326-00 Antelope Memorial Hospital
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Covered Entity Details
Entity Name
Antelope Memorial Hospital
Subdivision Name
Antelope Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH281326-00
Entity Address
102 West 9th Street
Neligh, NE 68756-1114
Medicare Provider Number
281326
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
BLOOD PHARMACY TILDEN
Pharmacy Address
103 E 2ND ST
PO BOX 127
TILDEN, NE 68781
Pharmacy Comments
Contract Details
Approval Date
2/9/2023
Contract Begin Date
2/9/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/25/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Martha Nelson, CFO
(402) 887-6282 Ext: 6282
Contract Pharmacy Representative
Blood Pharmacy LLC
Joshua Blood, Owner
(402) 887-5426
Signed By Date
2/9/2023
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