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WAL-MART PHARMACY 10-0885
CAH281339-02 MEMORIAL HEALTH CARE SYSTEMS DBA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL HEALTH CARE SYSTEMS DBA MEMORIAL HOSPITAL
Subdivision Name
UTICA FAMILY MEDICAL CENTER
Type
Critical Access Hospital
340B ID
CAH281339-02
Entity Address
100 4TH STREET
UTICA, NE 68456-6016
Medicare Provider Number
281339
Outpatient Facility Provider Number
283994
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0885
Pharmacy Address
1326 280TH ROAD
SEWARD, NE 68434
Pharmacy Comments
Contract Details
Approval Date
7/9/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
ROGER REAMER, CHIEF EXECUTIVE OFFICER
(402) 646-4629
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/9/2014
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