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WAL-MART PHARMACY 10-1332
CAH281349-00 PENDER COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PENDER COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281349-00
Entity Address
100 HOSPITAL DR
PENDER, NE 68047-0100
Medicare Provider Number
281349
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1332
Pharmacy Address
1601 CORNHUSKERS DRIVE
SOUTH SIOUX CITY, NE 68776
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Melissa Kelly, CFO/COO
(402) 385-4012
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/17/2017
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