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PRIEFERT PHARMACY
CAH281304-00 Thayer County Memorial Hospital dba Thayer County Health Services
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Covered Entity Details
Entity Name
Thayer County Memorial Hospital dba Thayer County Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281304-00
Entity Address
120 Park Avenue
Hebron, NE 68370
Medicare Provider Number
281304
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
PRIEFERT PHARMACY
Pharmacy Address
PRIEFERT PHARMACY, INC
428 LINCOLN AVE
HEBRON, NE 68370-1526
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/5/2020
Ownership change
Contacts
Covered Entity Signing Official
Michael Burcham, CEO
(402) 768-4614
Contract Pharmacy Representative
Jack Priefert, owner/RPh
(402) 768-6319
Signed By Date
1/14/2015
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