Covered Entity Details

CAH521315-00 Mayo Clinic Health System Northland (Active) - information as of 5/30/2025 8:15:45 PM

Main Details

Name

Mayo Clinic Health System Northland

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521315-00

Medicare Provider Number

521315

Additional Details

Current Program Status

Active

Registration Date

1/13/2014

Participating Start Date

4/1/2014

Participating Approval Date

1/31/2014

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

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

Primary Contact

Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853

Addresses

Street Address

1222 East Woodland Avenue
Barron, WI 54812

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 Northland
Barron Hospital Pharmacy
1222 East Woodland Avenue
Barron, WI 54812

Shipping Address 2

Mayo Clinic Health System Northland
Barron Outpatient Pharmacy
1222 East Woodland Avenue
Barron, WI 54812

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	07/15/2024	10/01/2024			10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11860	502 S. MAIN ST.	RICE LAKE	WI	54868-2576	04/12/2023	07/01/2023			07/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH521315-01	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Anesthesia	331 S MAIN STREET	RICE LAKE	WI	Active
CAH521315-02	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Otorhinolaryngology (ENT)	331 S MAIN STREET	RICE LAKE	WI	Active
CAH521315-03	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Orthopedic Surgery	331 S MAIN STREET	RICE LAKE	WI	Active
CAH521315-04	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Allergy & Immunology	331 S MAIN STREET	RICE LAKE	WI	Active
CAH521315-05	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Cardiac Diagnostic	331 S MAIN STREET	RICE LAKE	WI	Terminated
CAH521315-06	Child	CAH	Mayo Clinic Health System Northland	MCHS-NORTHLAND IN RICE LAKE - Gastroenterology & Hepatology	331 S MAIN STREET	RICE LAKE	WI	Active
CAH521315-07	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Physical Medicine and Rehabilitation	331 S Main St	Rice Lake	WI	Active
CAH521315-08	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Nutrition	331 S Main St	Rice Lake	WI	Terminated
CAH521315-09	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Palliative Medicine	331 S Main St	Rice Lake	WI	Terminated
CAH521315-10	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Nephrology	331 S Main St	Rice Lake	WI	Active
CAH521315-11	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Occupational Medicine	331 S Main St	Rice Lake	WI	Active
CAH521315-12	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Radiology	331 S Main St	Rice Lake	WI	Active
CAH521315-13	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Wound Care	331 S Main St	Rice Lake	WI	Active
CAH521315-14	Child	CAH	Mayo Clinic Health System Northland	MCHS Northland in Chetek - Radiology	220 Douglas Street	Chetek	WI	Terminated
CAH521315-15	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Pediatrics	331 S Main St	Rice Lake	WI	Active
CAH521315-16	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Obstetrics and Gynecology	331 S Main St	Rice Lake	WI	Active
CAH521315-17	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Chetek - Family Medicine	220 Douglas Street	Chetek	WI	Active
CAH521315-18	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Family Medicine	331 S Main St	Rice Lake	WI	Active
CAH521315-19	Child	CAH	Mayo Clinic Health System Northland	MCHS- Northland in Rice Lake - Urology	331 S Main St	Rice Lake	WI	Active
CAH521315-20	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Rice Lake Clinic - Dermatology	331 S MAIN ST STE H	Rice Lake	WI	Active
CAH521315-21	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Chetek Clinic - Anticoagulation	220 DOUGLAS ST	Chetek	WI	Active
CAH521315-22	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Rice Lake Clinic - Anticoagulation	331 S MAIN ST STE H	Rice Lake	WI	Active
CAH521315-23	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Rice Lake Clinic - Cardiovascular Disease	331 S MAIN ST STE H	Rice Lake	WI	Active
CAH521315-24	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Rice Lake Clinic - Psychiatry and Psychology	331 S MAIN ST STE H	Rice Lake	WI	Active
CAH521315-25	Child	CAH	Mayo Clinic Health System Northland	MCHS WI Rice Lake Clinic - Mobile Radiology	331 S MAIN STREET	RICE LAKE	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Buda, Alicia Operations Manager Mayo Clinic 5072933251	Lemin, Matt Program Manager Mayo Clinic Health System 5072933853	4/3/2025 1:49 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 4:18:02 PM	8/13/2024 8:28:00 AM	8/13/2024 8:28 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:13:58 AM	8/22/2023 4:18:02 PM	8/22/2023 4:18 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 10:13:46 AM	8/31/2022 11:13:58 AM	8/31/2022 11:13 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
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 10:13 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 8:17:34 AM	9/7/2021 10:13:46 AM	9/7/2021 10:13 AM
Details	Last Recertification Date	Update	Recertification	9/3/2019 10:46:30 AM	9/10/2020 8:17:34 AM	9/10/2020 8:17 AM
Addresses	Shipping Address	Delete	Change Request	MCHS Northland Hospital Pharmacy 1222 E. Woodland Ave Barron, WI 54812		4/23/2020 4:40 PM
Addresses	Shipping Address	Insert	Change Request		Mayo Clinic Health System Northland Barron Hospital Pharmacy 1222 East Woodland Avenue Barron, WI 54812	4/23/2020 4:40 PM
Addresses	Shipping Address	Insert	Change Request		Mayo Clinic Health System Northland Barron Outpatient Pharmacy 1222 East Woodland Avenue Barron, WI 54812	4/23/2020 4:40 PM
Details	Entity Name	Update	Change Request	Mayo Clinic Health System Northland Inc	Mayo Clinic Health System Northland	4/23/2020 4:40 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 1:32:48 PM	9/3/2019 10:46:30 AM	9/3/2019 10:46 AM
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	5/14/2019 6:10 AM
Addresses	Shipping Address	Insert	Recertification		MCHS Northland Hospital Pharmacy 1222 E. Woodland Ave Barron, WI 54812	8/22/2018 1:32 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 2:50:35 PM	8/22/2018 1:32:48 PM	8/22/2018 1:32 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/15/2017 2:50:35 PM	11/15/2017 2:50 PM
Contacts	Authorizing Official	Update	Change Request	Sullivan, Maurita Vice President 7155376769	Eberle, Michele Vice Chair-Administration NWWI Mayo Clinic 7155686113	10/17/2017 8:14 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			1222 East Woodland Avenue Barron, WI 54812	8/14/2017 8:16 AM
Contacts	Authorizing Official	Insert			Sullivan, Maurita Vice President 7155376769	8/14/2017 8:16 AM
Contacts	Signed By	Insert			Sullivan, Maurita Vice President 7155376769	8/14/2017 8:16 AM
Contacts	Primary Contact	Update		Finn, Paul Pharmacy Manager 7155778024	Miller, John Director-Pharmacy 7152337556	6/7/2017 9:21 AM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 2:02 PM
Contacts	Primary Contact	Insert			Finn, Paul Pharmacy Manager 7155778024	8/17/2015 4:27 PM
Details	Last Recertification Date	Update		8/13/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 11:31 AM
Details	Last Recertification Date	Update			8/13/2014 12:00:00 AM	8/13/2014 11:07 AM
Dates	Participating Approval Date	Update			1/31/2014 12:00:00 AM	1/31/2014 11:56 AM
Details	State	Update		Pending	Active	1/31/2014 11:56 AM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	1/31/2014 11:56 AM
Details	340B ID	Update		ONLINE_REG	CAH521315-00	1/16/2014 1:18 PM
Details	Last Recertification Date	Insert				1/13/2014 8:50 AM
Details	Grant Number	Insert				1/13/2014 8:50 AM
Details	340B ID	Insert			ONLINE_REG	1/13/2014 8:50 AM
Details	Is Authorizing Official EHB Data	Insert				1/13/2014 8:50 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2014 8:50 AM
Details	Medicare Provider Number	Insert			521315	1/13/2014 8:50 AM
Details	Entity Name	Insert			Mayo Clinic Health System Northland Inc	1/13/2014 8:50 AM
Details	Program Code	Insert			CAH	1/13/2014 8:50 AM
Details	Entity Subname	Insert				1/13/2014 8:50 AM
Dates	Participating Approval Date	Insert				1/13/2014 8:50 AM
Details	State	Insert			Pending	1/13/2014 8:50 AM
Dates	Registration Date	Insert			1/13/2014 12:00:00 AM	1/13/2014 8:50 AM
Dates	Signed By Date	Insert			1/13/2014 12:00:00 AM	1/13/2014 8:50 AM
Dates	Start Date	Insert				1/13/2014 8:50 AM
Terminations	Termination Comments	Insert				1/13/2014 8:50 AM
Terminations	Termination Date	Insert				1/13/2014 8:50 AM
Terminations	Termination Effective Date	Insert				1/13/2014 8:50 AM
Terminations	Termination Reason	Insert				1/13/2014 8:50 AM