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U-SAVE PHARMACY
CAH281345-00 Providence Medical Center
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Covered Entity Details
Entity Name
Providence Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281345-00
Entity Address
1200 Providence Rd
Wayne, NE 68787
Medicare Provider Number
281345
Participating Start Date
10/1/2012
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
U-SAVE PHARMACY
Pharmacy Address
216 E 7TH ST
WAYNE, NE 68787
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Gearhart, CEO
(402) 375-3800
Contract Pharmacy Representative
U-Save Pharmacy
Mark Patefield, Pharmacy Owner
(402) 375-2922
Signed By Date
1/16/2024
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