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SHOPKO PHARMACY #2175
DSH280013 THE NEBRASKA MEDICAL CENTER
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Covered Entity Details
Entity Name
THE NEBRASKA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH280013
Entity Address
989200 Nebraska Medical Center
Omaha, NE 68198
Medicare Provider Number
280013
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2175
Pharmacy Address
6845 SOUTH 27TH STREET
LINCOLN, NE 68512
Pharmacy Comments
Contract Details
Approval Date
10/27/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/8/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Dinsmoor, CEO
(402) 552-3202
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
10/27/2014
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