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KOHLL'S PHARMACY & HOMECARE
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
KOHLL'S PHARMACY & HOMECARE
Pharmacy Address
5000 DODGE STREET
OMAHA, NE 68132
Pharmacy Comments
Contract Details
Approval Date
4/10/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2019
Ownership change
Contacts
Covered Entity Signing Official
Stephanie Daubert, CFO
(402) 552-2889
Contract Pharmacy Representative
Kohll's RX
David Kohll, President
(402) 895-6812
Signed By Date
4/10/2015
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