Contract Pharmacy Details

WALMART PHARMACY 10-3152
DSH280013 THE NEBRASKA MEDICAL CENTER

Covered Entity Details

Entity Name

THE NEBRASKA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH280013

Entity Address

989200 Nebraska Medical Center
Omaha, NE 68198

Medicare Provider Number

280013

Participating Start Date

12/1/1992

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

WALMART PHARMACY 10-3152

Pharmacy Address

2451 N 90TH ST
OMAHA, NE 68134

Pharmacy Comments

Contract Details

Approval Date

4/17/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephanie Daubert, CFO
(402) 552-2889

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/17/2018

340B Drug Pricing Program Database