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SMITH'S FOOD & DRUG CTRS
DSH290007 UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290007
Entity Address
1800 W Charleston Blvd.
LAS VEGAS, NV 89102
Medicare Provider Number
290007
Participating Start Date
7/1/1994
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
SMITH'S FOOD & DRUG CTRS
Pharmacy Address
SMITH'S FOOD & DRUG #383
4440 N RANCHO DR
LAS VEGAS, NV 89130
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
Brian Brannman, CEO
(702) 383-3862
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/16/2014
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