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U SAVE PHARMACY OGALLALA
CAH281356-00 PERKINS COUNTY HEALTH SERVICES
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Covered Entity Details
Entity Name
PERKINS COUNTY HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281356-00
Entity Address
900 Lincoln Avenue
GRANT, NE 69140
Medicare Provider Number
281356
Participating Start Date
10/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
U SAVE PHARMACY OGALLALA
Pharmacy Address
USPRX INC
23 N SPRUCE ST
OGALLALA, NE 69153
Pharmacy Comments
Contract Details
Approval Date
10/12/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Derick Lorentz, CFO
(308) 352-7228
Contract Pharmacy Representative
U-Save Pharmacy
Brian Wilson, Owner
(308) 284-2242
Signed By Date
10/12/2015
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