Covered Entity Details

CAH521340-02 Mayo Clinic Health System - Red Cedar (Terminated) - information as of 6/24/2025 12:01:04 AM

Main Details

Name

Mayo Clinic Health System - Red Cedar

Subdivision Name

MCHS- Red Cedar in Elmwood- Family Medicine

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521340-02

Medicare Provider Number

521340

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/8/2013

Participating Start Date

4/1/2013

Participating Approval Date

1/14/2013

Last Recertification Date

9/7/2021

Termination Date
Termination Reason

4/1/2022
Site closure

Contacts

Authorizing Official

Mayo Clinic
Michele Eberle, Vice Chair-Administration NWWI
(715) 568-6113

Primary Contact

Mayo Clinic
Alicia Buda, Operations Manager
(507) 293-3251

Addresses

Street Address

236 East Springer Avenue
Elmwood, WI 54740

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

Shipping Address 1

Mayo Clinic Health System--Red Cedar in Menomonie Hospital Pharmacy
2321 Stout Road
Menomonie, WI 54751

Shipping Address 2

Mayo Clinic Health System--Red Cedar in Menomonie Outpatient Pharmacy
2321 Stout Road
Menomonie, WI 54751

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
Contract Detail	MAYO CLINIC PHARMACY	3551 Commercial Dr SW		Rochester	MN	55902	01/13/2020	04/01/2020		04/01/2022	04/01/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH521340-01	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS- Red Cedar in Glenwood City: Family Medicine	219 East Oak St.	Glenwood City	WI	Active
CAH521340-02	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS- Red Cedar in Elmwood- Family Medicine	236 East Springer Avenue	Elmwood	WI	Terminated
CAH521340-03	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Glenwood City - Physical Medicine and Rehabilitation	219 E Oak St	Glenwood City	WI	Active
CAH521340-04	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Glenwood City - Radiology	219 E Oak St	Glenwood City	WI	Terminated
CAH521340-05	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Elmwood - Internal Medicine	236 E Springer Ave	Elmwood	WI	Terminated
CAH521340-06	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Occupational Medicine	2407 Stout Rd	Menomonie	WI	Active
CAH521340-07	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Orthopedics	2407 Stout Rd	Menomonie	WI	Active
CAH521340-08	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Physical Medicine and Rehabilitation	2407 Stout Rd	Menomonie	WI	Active
CAH521340-09	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Physical Therapy	2407 Stout Rd	Menomonie	WI	Active
CAH521340-10	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar - Behavioral Health	2411 Stout Rd	Menomonie	WI	Active
CAH521340-11	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Pain Medicine	2407 Stout Road	Menomonie	WI	Active
CAH521340-12	Child	CAH	Mayo Clinic Health System - Red Cedar	Orthopedic & Rehabilitation Center - Family Medicine	2407 Stout Road	Menomonie	WI	Terminated
CAH521340-13	Child	CAH	Mayo Clinic Health System - Red Cedar	Menomonie - Neurological Surgery	2407 Stout Road	Menomonie	WI	Active
CAH521340-14	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS WI Orthopedic and Rehab Center - Dermatology	2407 Stout Rd	Menonomonie	WI	Active
CAH521340-15	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS WI Menomonie 2403 Building - Psychiatry and Psychology	2403 Stout Road	Menomonie	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/31/2021 12:00:00 AM	1/26/2022 7:20 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/26/2022 7:20 AM
Terminations	Termination Comments	Update	Termination Request		Elmwood closure effective 1/1/22	1/26/2022 7:20 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	1/26/2022 7:20 AM
Terminations	Termination Effective Date	Update	Termination Request		12/31/2021 12:00:00 AM	1/26/2022 7:20 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	1/26/2022 7:20 AM
Contacts	Primary Contact	Update	Profile Change Request	Buda, Alicia M. E. Operations Manager Mayo Clinic 5072553648	Buda, Alicia Operations Manager Mayo Clinic 5072933251	12/21/2021 2:39 PM
Addresses	Shipping Address	Delete	Recertification	MCHS Red Cedar Hospital Pharmacy 2321 Stout Road Menomonie, WI 54751		9/7/2021 10:26 AM
Addresses	Shipping Address	Delete	Recertification	MCHS Red Cedar Outpatient Pharmacy 2321 Stout Road Menomonie, WI 54751		9/7/2021 10:26 AM
Addresses	Shipping Address	Insert	Recertification		Mayo Clinic Health System--Red Cedar in Menomonie Hospital Pharmacy 2321 Stout Road Menomonie, WI 54751	9/7/2021 10:26 AM
Addresses	Shipping Address	Insert	Recertification		Mayo Clinic Health System--Red Cedar in Menomonie Outpatient Pharmacy 2321 Stout Road Menomonie, WI 54751	9/7/2021 10:26 AM
Contacts	Primary Contact	Update	Recertification	Christopherson, Darrin Senior Business Analyst-340B Midwest Programs Mayo Clinic 5072845035	Buda, Alicia M. E. Operations Manager Mayo Clinic 5072553648	9/7/2021 10:26 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 2:49:35 PM	9/7/2021 10:26:56 AM	9/7/2021 10:26 AM
Contacts	Authorizing Official	Update	Change Request	Lindberg, Steven Vice President- Red Cedar Mayo Clinic 7152337414	Eberle, Michele Vice Chair-Administration NWWI Mayo Clinic 7155686113	2/19/2021 10:29 AM
Details	Entity Subname	Update	Change Request	Elmwood: Family Medicine	MCHS- Red Cedar in Elmwood- Family Medicine	9/16/2020 11:41 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 12:09:15 PM	9/10/2020 2:49:35 PM	9/10/2020 2:49 PM
Details	Entity Subname	Update	Change Request	Elmwood	Elmwood: Family Medicine	7/28/2020 9:06 AM
Details	Entity Name	Update	Change Request	Mayo Clinic Health System - Red Cedar Inc.	Mayo Clinic Health System - Red Cedar	4/27/2020 8:19 AM
Details	Last Recertification Date	Update	Recertification	8/24/2018 11:46:34 AM	9/10/2019 12:09:15 PM	9/10/2019 12:09 PM
Contacts	Primary Contact	Update	Change Request	Hovell, Jenni 340B Operations Manager Mayo Clinic 5072845061	Christopherson, Darrin Senior Business Analyst-340B Midwest Programs Mayo Clinic 5072845035	5/15/2019 12:21 PM
Addresses	Shipping Address	Insert	Recertification		MCHS Red Cedar Hospital Pharmacy 2321 Stout Road Menomonie, WI 54751	8/24/2018 11:46 AM
Addresses	Shipping Address	Insert	Recertification		MCHS Red Cedar Outpatient Pharmacy 2321 Stout Road Menomonie, WI 54751	8/24/2018 11:46 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 10:11:09 AM	8/24/2018 11:46:34 AM	8/24/2018 11:46 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/21/2017 10:11:09 AM	11/21/2017 10:11 AM
Contacts	Authorizing Official	Update		Lindberg, Steven Vice President- Red Cedar 7152337414	Lindberg, Steven Vice President- Red Cedar Mayo Clinic 7152337414	11/21/2017 10:08 AM
Contacts	Primary Contact	Update		Hovell, Jenni 340B Operations Manager 5072845061	Hovell, Jenni 340B Operations Manager Mayo Clinic 5072845061	9/27/2017 5:15 PM
Contacts	Primary Contact	Update		Miller, John Director-Pharmacy 7152337556	Hovell, Jenni 340B Operations Manager 5072845061	8/14/2017 6:23 PM
Addresses	Main Address	Insert			236 East Springer Avenue Elmwood, WI 54740	8/14/2017 10:46 AM
Contacts	Authorizing Official	Insert			Lindberg, Steven Vice President- Red Cedar 7152337414	8/14/2017 10:46 AM
Contacts	Signed By	Insert			Lubinsky, Jeanie Chief Financial Officer 7152337681	8/14/2017 10:46 AM
Contacts	Primary Contact	Insert			Miller, John Director-Pharmacy 7152337556	8/10/2016 9:45 AM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 9:45 AM
Details	Last Recertification Date	Update		8/13/2014 12:00:00 AM	8/11/2015 12:00:00 AM	8/11/2015 9:44 AM
Details	Last Recertification Date	Update		8/21/2013 12:00:00 AM	8/13/2014 12:00:00 AM	8/13/2014 10:00 AM
Details	Last Recertification Date	Update			8/21/2013 12:00:00 AM	8/21/2013 12:30 PM
Details	340B ID	Update		ISAPCAH521340-02	CAH521340-02	1/14/2013 1:33 PM
Dates	Participating Approval Date	Update			1/14/2013 12:00:00 AM	1/14/2013 1:33 PM
Details	State	Update		Pending	Active	1/14/2013 1:33 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	1/14/2013 1:33 PM
Details	340B ID	Update		AP010913	ISAPCAH521340-02	1/11/2013 12:35 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	AP010913	1/9/2013 2:37 PM
Details	Last Recertification Date	Insert				1/8/2013 4:18 PM
Details	Grant Number	Insert				1/8/2013 4:18 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/8/2013 4:18 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2013 4:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2013 4:18 PM
Details	Medicare Provider Number	Insert			521340	1/8/2013 4:18 PM
Details	Entity Name	Insert			Mayo Clinic Health System - Red Cedar Inc.	1/8/2013 4:18 PM
Details	Program Code	Insert			CAH	1/8/2013 4:18 PM
Details	Entity Subname	Insert			Elmwood	1/8/2013 4:18 PM
Dates	Participating Approval Date	Insert				1/8/2013 4:18 PM
Details	State	Insert			Pending	1/8/2013 4:18 PM
Dates	Registration Date	Insert			1/8/2013 12:00:00 AM	1/8/2013 4:18 PM
Dates	Signed By Date	Insert			1/8/2013 12:00:00 AM	1/8/2013 4:18 PM
Dates	Start Date	Insert				1/8/2013 4:18 PM
Terminations	Termination Comments	Insert				1/8/2013 4:18 PM
Terminations	Termination Date	Insert				1/8/2013 4:18 PM
Terminations	Termination Effective Date	Insert				1/8/2013 4:18 PM
Terminations	Termination Reason	Insert				1/8/2013 4:18 PM