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GRANT PHARMACY
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
GRANT PHARMACY
Pharmacy Address
J&J PHARMACIES
218 CENTRAL AVE
GRANT, NE 69140
Pharmacy Comments
Contract Details
Approval Date
10/12/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Derick Lorentz, CFO
(308) 352-7228
Contract Pharmacy Representative
Grant Pharmacy
Jason Burke, Co-owner
(308) 352-4511
Signed By Date
10/12/2015
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