Contract Pharmacy Details

SHOPKO PHARMACY #2523
CAH281344-00 Cherry County Hospital

Covered Entity Details

Entity Name

Cherry County Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH281344-00

Entity Address

510 N Green St
Valentine, NE 69201-0000

Medicare Provider Number

281344

Participating Start Date

10/1/2013

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2523

Pharmacy Address

525 E HIGHWAY 20
VALENTINE, NE 69201

Pharmacy Comments

Contract Details

Approval Date

1/13/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/28/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Peggy J. Snell, CFO
(402) 376-2525 Ext: 122

Contract Pharmacy Representative

Greg Ahmann, VP Regional Pharmacy
(920) 429-4879

Signed By Date

1/13/2014