Covered Entity Details

SCH520109-07 MILE BLUFF MEDICAL CENTER INC. (Approved) - information as of 5/6/2025 12:01:16 AM

Main Details

Name

MILE BLUFF MEDICAL CENTER INC.

Subdivision Name

Delton Family Medical Center - Family Practice

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH520109-07

Medicare Provider Number

520109

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/22/2025

Last Recertification Date

Contacts

Authorizing Official

Mile Bluff Medical Center
Dara Beth Bartels, Chief Executive Officer
(608) 847-2992

Primary Contact

Mile Bluff Medical Center
Craig William Griffis, Director of Pharmacy
(608) 847-1255

Addresses

Street Address

28 Commerce Street
Wisconsin Dells, WI 53965

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH520109-01	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	Elroy Family Medical Center / Family Practice, OB, Podiatry	1515 Academy Street	Elroy	WI	Active
SCH520109-02	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	Necedah Family Medical Center / Family Practice, Obstetrics, Podiatry, Radiology	1408 Wheelihan Avenue	Necedah	WI	Active
SCH520109-03	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	Mile Bluff Dialysis Center	1040 Division Street	Mauston	WI	Active
SCH520109-04	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	MILE BLUFF MEDICAL CENTER INC / Mile Bluff Clinic	1040 DIVISION ST	MAUSTON	WI	Active
SCH520109-05	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	MILE BLUFF MEDICAL CENTER INC / New Lisbon Family Medicine	901W BRIDGE ST	NEW LISBON	WI	Active
SCH520109-06	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	Wisconsin Dells Dialysis Center - Dialysis	28 Commerce Street	Wisconsin Dells	WI	Active
SCH520109-07	Child	SCH	MILE BLUFF MEDICAL CENTER INC.	Delton Family Medical Center - Family Practice	28 Commerce Street	Wisconsin Dells	WI	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Bartels, Dara Beth Chief Executive Officer Mile Bluff Medical Center 6088472992	4/22/2025 1:04 PM
Details	340B ID	Update	New Registration		SCH520109-07	4/22/2025 1:04 PM
Details	Entity Name	Update	New Registration	MILE BLUFF MEDICAL CENTER INC.	MILE BLUFF MEDICAL CENTER INC.	4/22/2025 1:04 PM
Details	Entity Subname	Update	New Registration	Delton Family Medical Center	Delton Family Medical Center - Family Practice	4/22/2025 1:04 PM
Dates	Participating Approval Date	Update	New Registration		4/22/2025 1:04:34 PM	4/22/2025 1:04 PM
Details	State	Update	New Registration	Pending	Approved	4/22/2025 1:04 PM
Dates	Signed By Date	Update	New Registration		4/21/2025 4:00:33 PM	4/22/2025 1:04 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/22/2025 1:04 PM
Addresses	Main Address	Insert	New Registration		28 Commerce Street Wisconsin Dells, WI 53965	4/11/2025 11:43 AM
Contacts	Primary Contact	Insert	New Registration		Griffis, Craig William Director of Pharmacy Mile Bluff Medical Center 6088471255	4/11/2025 11:43 AM
Contacts	Authorizing Official	Insert	New Registration		Bartels, Dara Beth Chief Executive Officer Mile Bluff Medical Center 6088472992	4/11/2025 11:43 AM
Details	Assistance Received From Date	Insert	New Registration			4/11/2025 11:43 AM
Details	Assistance Received To Date	Insert	New Registration			4/11/2025 11:43 AM
Details	Last Recertification Date	Insert	New Registration			4/11/2025 11:43 AM
Details	Grant Number	Insert	New Registration			4/11/2025 11:43 AM
Details	340B ID	Insert	New Registration			4/11/2025 11:43 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2025 11:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2025 11:43 AM
Details	Medicare Provider Number	Insert	New Registration		520109	4/11/2025 11:43 AM
Details	Entity Name	Insert	New Registration		MILE BLUFF MEDICAL CENTER INC.	4/11/2025 11:43 AM
Details	NOFO Number	Insert	New Registration			4/11/2025 11:43 AM
Details	Program Code	Insert	New Registration		SCH	4/11/2025 11:43 AM
Details	Entity Subname	Insert	New Registration		Delton Family Medical Center	4/11/2025 11:43 AM
Dates	Participating Approval Date	Insert	New Registration			4/11/2025 11:43 AM
Details	State	Insert	New Registration		Pending	4/11/2025 11:43 AM
Dates	Registration Date	Insert	New Registration		4/11/2025 11:43:21 AM	4/11/2025 11:43 AM
Dates	Signed By Date	Insert	New Registration			4/11/2025 11:43 AM
Dates	Start Date	Insert	New Registration			4/11/2025 11:43 AM
Terminations	Termination Comments	Insert	New Registration			4/11/2025 11:43 AM
Terminations	Termination Date	Insert	New Registration			4/11/2025 11:43 AM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2025 11:43 AM
Terminations	Termination Reason	Insert	New Registration			4/11/2025 11:43 AM