Contract Pharmacy Details

WALGREEN CO.
DSH280013 THE NEBRASKA MEDICAL CENTER

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03694
1802 GALVIN ROAD SOUTH
BELLEVUE, NE 68005

Pharmacy Comments

Contract Details

Approval Date

4/14/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephanie Daubert, CFO
(402) 552-2889

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/14/2015

340B Drug Pricing Program Database