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Walmart Pharmacy 10-7611
CAH281357-00 Cheyenne County Hospital Association, Inc. DBA Sidney Regional Medical Center
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Covered Entity Details
Entity Name
Cheyenne County Hospital Association, Inc. DBA Sidney Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281357-00
Entity Address
1000 Pole Creek Crossing
Sidney, NE 69162
Medicare Provider Number
281357
Participating Start Date
1/1/2012
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Petik, CEO
(308) 254-5070
Contract Pharmacy Representative
Sidney Regional Medical Center
Julie Ann Slagle, Vice President Patient Care Services
(308) 254-7268 Ext: 1425
Signed By Date
10/16/2023
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