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WAL-MART PHARMACY 10-2432
CAH281354-00 CRETE AREA MEDICAL CENTER
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Covered Entity Details
Entity Name
CRETE AREA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281354-00
Entity Address
2910 BETTEN DRIVE
CRETE, NE 68333
Medicare Provider Number
281354
Participating Start Date
1/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2432
Pharmacy Address
2500 JAMIE LANE
LINCOLN, NE 68512
Pharmacy Comments
Contract Details
Approval Date
1/7/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/20/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRYCE K. BETKE, CFO
(402) 826-7945
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/7/2014
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