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WAL-MART PHARMACY 10-3154
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
WAL-MART PHARMACY 10-3154
Pharmacy Address
2109 TOWNE CENTER DR.
BELLEVUE, NE 68123
Pharmacy Comments
Contract Details
Approval Date
1/9/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie Daubert, CFO
(402) 552-2889
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/9/2015
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