340B Drug Pricing Program Database


DSH520087AL Gundersen Lutheran Medical Center, Inc. (Active) - information as of 6/9/2025 11:02:00 PM

Main Details
Gundersen Lutheran Medical Center, Inc.
Main Clinic - Laboratory Clinic La Crosse
Disproportionate Share Hospital
Yes
DSH520087AL
520087
520087


Additional Details
Active
7/3/2014
10/1/2014
9/9/2014
8/28/2024

Contacts

Gundersen Health system
Michelle Micka, VP Finance
(608) 775-3131 Ext: 53131

Gundersen Health System
Loren Carrell, Director
(608) 775-6369

Addresses

1836 South Ave
La Crosse, WI 54601

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WI110129001376593442
MN7653476001376593442
IA06990171376593442
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH520087AChildDSHGundersen Lutheran Medical Center, Inc.Hemodialysis - Prairie du Chien610 E. Taylor StreetPrairie du ChienWIActive
DSH520087AAChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Center for Breast Care1836 South AveLa CrosseWITerminated
DSH520087ABChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Nuclear Medicine1836 South AveLa CrosseWITerminated
DSH520087ACChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Intervential Radiology1836 South AveLa CrosseWITerminated
DSH520087ADChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Ultrasound1836 South AveLa CrosseWITerminated
DSH520087AEChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Ultrasound3111 Gundersen DriveOnalaskaWIActive
DSH520087AFChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - OB/Gyn3111 Gundersen DriveOnalaskaWIActive
DSH520087AGChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Radiology Diagnostic3111 Gundersen DriveOnalaskaWIActive
DSH520087AHChildDSHGundersen Lutheran Medical Center, Inc.East Building - Radiation Oncology724 Denton StLa CrosseWIActive
DSH520087AJChildDSHGundersen Lutheran Medical Center, Inc.East Buidling - CT Scan724 Denton StLa CrosseWIActive
DSH520087AKChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - CT Scan3111 Gundersen DriveOnalaskaWIActive
DSH520087ALChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Laboratory Clinic La Crosse1836 South AveLa CrosseWIActive
DSH520087AMChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Laboratory3111 Gundersen DriveOnalaskaWIActive
DSH520087ANChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Pulmonary3111 Gundersen DriveOnalaskaWIActive
DSH520087APChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Audiology1836 South AveLa CrosseWIActive
DSH520087AQChildDSHGundersen Lutheran Medical Center, Inc.East Building - Speech724 Denton StLa CrosseWIActive
DSH520087ARChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Cardiology La Crosse1836 South AveLa CrosseWIActive
DSH520087ASChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Cardiology3111 Gundersen DriveOnalaskaWIActive
DSH520087ATChildDSHGundersen Lutheran Medical Center, Inc.East Building - Neurosurgery724 Denton StLa CrosseWIActive
DSH520087AUChildDSHGundersen Lutheran Medical Center, Inc.East Building - Neurology724 Denton StLa CrosseWIActive
DSH520087AVChildDSHGundersen Lutheran Medical Center, Inc.Founders Building - Sleep Lab710 Denton StLa CrosseWIActive
DSH520087AWChildDSHGundersen Lutheran Medical Center, Inc.East Building - Medical Oncology La Crosse724 Denton StLa CrosseWIActive
DSH520087AXChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Medical Oncology3111 Gundersen DriveOnalaskaWIActive
DSH520087AYChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Nephrology1836 South AveLa CrosseWITerminated
DSH520087AZChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Pediatrics La Crosse1836 South AveLa CrosseWIActive
DSH520087BChildDSHGundersen Lutheran Medical Center, Inc.Hemodialysis - Tomah505 Gopher DriveTomahWIActive
DSH520087BAChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Cardiothoracic Surgery1836 South AveLa CrosseWIActive
DSH520087BBChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Surgery Clinic1836 South AveLa CrosseWIActive
DSH520087BCChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Bariatric Surgical Services La Crosse1836 South AveLa CrosseWIActive
DSH520087BDChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Bariatric Surgical Services3111 Gundersen DrOnalaskaWIActive
DSH520087BEChildDSHGundersen Lutheran Medical Center, Inc.East Building - Opthalmology724 Denton StLa CrosseWIActive
DSH520087BFChildDSHGundersen Lutheran Medical Center, Inc.East Building - Optometry La Crosse724 Denton StLa CrosseWIActive
DSH520087BGChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Orthopedic Surgery1836 South AveLa CrosseWIActive
DSH520087BHChildDSHGundersen Lutheran Medical Center, Inc.East Building - Podiatry La Crosse724 Denton StLa CrosseWIActive
DSH520087BJChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Otolaryngology1836 South AveLa CrosseWIActive
DSH520087BKChildDSHGundersen Lutheran Medical Center, Inc.East Building - Plastic Surgery724 Denton StLa CrosseWIActive
DSH520087BLChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Urology La Crosse1836 South AveLa CrosseWIActive
DSH520087BMChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Urology Onalaksa3111 Gundersen DriveOnalaskaWIActive
DSH520087BNChildDSHGundersen Lutheran Medical Center, Inc.East Building - Physical Medicine and Rehab724 Denton StLa CrosseWIActive
DSH520087BPChildDSHGundersen Lutheran Medical Center, Inc.Founder's Building - Injection Clinic710 Denton StLa CrosseWIActive
DSH520087BQChildDSHGundersen Lutheran Medical Center, Inc.East Building - Palliative Care724 Denton StLa CrosseWIActive
DSH520087BRChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Dermatology3111 Gundersen DriveOnalaskaWIActive
DSH520087BSChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Family Medicine3111 Gundersen DriveOnalaskaWIActive
DSH520087BTChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Rheumatoloogy3111 Gundersen DriveOnalaskaWIActive
DSH520087BUChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Pediatrics3111 Gundersen DriveOnalaskaWIActive
DSH520087BVChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - General Surgery3111 Gundersen DriveOnalaskaWIActive
DSH520087BWChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Fertility Center3111 Gundersen DriveOnalaskaWITerminated
DSH520087BXChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Opthalmology3111 Gundersen DriveOnalaskaWIActive
DSH520087BYChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Optometry3111 Gundersen DriveOnalaskaWIActive
DSH520087BZChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Orthopedic Surgery3111 Gundersen DriveOnalaskaWIActive
DSH520087CChildDSHGundersen Lutheran Medical Center, Inc.Hemodialysis - Onalaska3075 Kinney Coulee RoadOnalaskaWIActive
DSH520087CAChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Sports Medicine3111 Gundersen DriveOnalaskaWIActive
DSH520087CBChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Podiatry3111 Gundersen DriveOnalaskaWIActive
DSH520087CCChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Urgent Care3111 Gundersen DriveOnalaskaWIActive
DSH520087CDChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Annex - Transitional Services123 16th Ave S.OnalaskaWIActive
DSH520087CEChildDSHGundersen Lutheran Medical Center, Inc.East Building - Neuropsychology724 Denton StLa CrosseWIActive
DSH520087CFChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - OB/Gyn La Crosse1836 South AveLa CrosseWIActive
DSH520087CGChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CTR INC / IV Therapy1836 SOUTH AVELA CROSSEWIActive
DSH520087CHChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN RENAL DIALYSIS- / Renal OP - Richland1313W SEMINARY STRICHLAND CENTERWITerminated
DSH520087CJChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CENTER I / Renal OP - Viroqua407S MAIN ST 300VIROQUAWITerminated
DSH520087CKChildDSHGundersen Lutheran Medical Center, Inc.Hospice Home724 DentonLa CrosseWIActive
DSH520087CLChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CTR INC / Preadmission1836 SOUTH AVELA CROSSEWIActive
DSH520087CMChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CTR INC / Vascular Institute1836 SOUTH AVELA CROSSEWIActive
DSH520087CNChildDSHGundersen Lutheran Medical Center, Inc.East Building / Laboratory724 DENTON STLA CROSSEWIActive
DSH520087CPChildDSHGundersen Lutheran Medical Center, Inc.East Building / MRI724 DENTON STLA CROSSEWIActive
DSH520087CRChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic / Otolaryngology3111 GUNDERSEN DRONALASKAWIActive
DSH520087CSChildDSHGundersen Lutheran Medical Center, Inc.East Building / Outpatient Surgery Center Pre & Post Operations724 DENTON STLA CROSSEWIActive
DSH520087CTChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic / Audiology3111 GUNDERSEN DRONALASKAWIActive
DSH520087CUChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic / Occupational Therapy1836 SOUTH AVELACROSSEWIActive
DSH520087CVChildDSHGundersen Lutheran Medical Center, Inc.Onalaska / Physical Therapy3111 GUNDERSEN DRONALASKAWIActive
DSH520087CWChildDSHGundersen Lutheran Medical Center, Inc.East Building / Physical Therapy724 DENTON STLA CROSSEWIActive
DSH520087CXChildDSHGundersen Lutheran Medical Center, Inc.East Building / Diagnostic Radiology724 DENTON STLA CROSSEWIActive
DSH520087CYChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Peds OT1836 South AveLa CrosseWITerminated
DSH520087CZChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Peds PT1836 South AveLa CrosseWIActive
DSH520087DChildDSHGundersen Lutheran Medical Center, Inc.Hemodialysis - Black River Falls711 Adams StreetBlack River FallsWITerminated
DSH520087DAChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CENTER - Infusion1122 W HIGHWAY 61WINONAMNActive
DSH520087DBChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Imaging1122 West Hwy. 61WinonaMNActive
DSH520087DCChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CENTER - Laboratory1122 W HIGHWAY 61WINONAMNActive
DSH520087DDChildDSHGundersen Lutheran Medical Center, Inc.GUNDERSEN LUTHERAN MEDICAL CENTER - Urgent Care1122 W HIGHWAY 61WINONAMNActive
DSH520087DEChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Outpatient Surgery Center1122 West Hwy. 61WinonaMNActive
DSH520087DFChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Neurology1122 West Hwy. 61WinonaMNActive
DSH520087DGChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus -Pediatrics1122 West Hwy. 61WinonaMNActive
DSH520087DHChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - General Internal Medicine1122 West Hwy. 61WinonaMNActive
DSH520087DJChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Family Medicine1122 West Hwy. 61WinonaMNActive
DSH520087DKChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Gastroenterology1122 West Hwy. 61WinonaMNActive
DSH520087DLChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Sleep Lab1122 West Hwy. 61WinonaMNActive
DSH520087DMChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona - Therapy1122 West Hwy. 61WinonaMNActive
DSH520087DNChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Audiology1122 West Hwy. 61WinonaMNActive
DSH520087DPChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - OB/GYN1122 West Hwy. 61WinonaMNActive
DSH520087DQChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Optometry1122 West Hwy. 61WinonaMNActive
DSH520087DRChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Podiatry1122 West Hwy. 61WinonaMNActive
DSH520087DSChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Orthopedics/Sports Medicine1122 West Hwy. 61WinonaMNActive
DSH520087DTChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - General Surgery1122 West Hwy. 61WinonaMNActive
DSH520087DUChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Otolaryngology1122 West Hwy. 61WinonaMNActive
DSH520087DVChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Physical Medical Rehab1122 West Hwy. 61WinonaMNActive
DSH520087DWChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Winona Shared Specialties1122 West Hwy. 61WinonaMNActive
DSH520087DXChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Pain Medicine1122 West Hwy. 61WinonaMNActive
DSH520087DYChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Anesthesiology1122 West Hwy. 61WinonaMNActive
DSH520087DZChildDSHGundersen Lutheran Medical Center, Inc.Winona Campus - Winona Campus - Ophthalmology1122 West Hwy. 61WinonaMNActive
DSH520087EChildDSHGundersen Lutheran Medical Center, Inc.Behavioral Health - Onalaska123 16th Ave S.OnalaskaWIActive
DSH520087EAChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - La Crosse Flu Shot Clinic1836 South AveLa CrosseWIActive
DSH520087EBChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Physical Medicine and Rehab3111 Gundersen DriveOnalaskaWIActive
DSH520087ECChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic - Onalaska Flu Shot Clinic3111 Gundersen DriveOnalaskaWIActive
DSH520087FChildDSHGundersen Lutheran Medical Center, Inc.Behavioral health - Onalaska Clinic3111 Gundersen DriveOnalaskaWIActive
DSH520087GChildDSHGundersen Lutheran Medical Center, Inc.Outpatient AODA Services - Unity House for Women1918-1924 Miller StreetLa CrosseWITerminated
DSH520087HChildDSHGundersen Lutheran Medical Center, Inc.Unity House for Men1312 5th Avenue SouthLa CrosseWITerminated
DSH520087JChildDSHGundersen Lutheran Medical Center, Inc.Wound Clinic1836 South AvenueLa CrosseWIActive
DSH520087KChildDSHGundersen Lutheran Medical Center, Inc.Infusion - La Crosse724 Denton StreetLa CrosseWIActive
DSH520087LChildDSHGundersen Lutheran Medical Center, Inc.Emergency (Urgent Care)1900 South AvenueLa CrosseWITerminated
DSH520087MChildDSHGundersen Lutheran Medical Center, Inc.Medlink Air1900 South AvenueLa CrosseWIActive
DSH520087NChildDSHGundersen Lutheran Medical Center, Inc.Pain Management & Outpatient Surgery724 Denton StreetLa CrosseWIActive
DSH520087PChildDSHGundersen Lutheran Medical Center, Inc.Infusion- Onalaska Clinic3111 Gundersen DriveOnalaskaWIActive
DSH520087QChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic-Endocrinology La Crosse1836 South AveLa CrosseWIActive
DSH520087RChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic-Infectious Disease1836 South AveLa CrosseWIActive
DSH520087SChildDSHGundersen Lutheran Medical Center, Inc.East Building-Hematology724 Denton StLa CrosseWIActive
DSH520087TChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic-General Internal Medicine Onalaska3111 Gundersen DriveOnalaskaWIActive
DSH520087UChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic-General Internal Medicine La Crosse1836 South AveLa CrosseWIActive
DSH520087VChildDSHGundersen Lutheran Medical Center, Inc.Founders Building-Family Medicine La Crosse710 Denton StLa CrosseWIActive
DSH520087WChildDSHGundersen Lutheran Medical Center, Inc.Onalaska Clinic-Endocrinology Onalaska3111 Gundersen DriveOnalaskaWIActive
DSH520087YChildDSHGundersen Lutheran Medical Center, Inc.Main Clinic - Diagnostic Radiology La Crosse1836 South AveLa CrosseWITerminated
DSH520087ZChildDSHGundersen Lutheran Medical Center, Inc.East Building - Center for Breast Care724 Denton StLa CrosseWIActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/5/2023 6:34:10 PM8/28/2024 1:19:22 PM8/28/2024 1:19 PM
DetailsLast Recertification DateUpdateRecertification8/30/2022 9:32:50 AM9/5/2023 6:34:10 PM9/5/2023 6:34 PM
ContactsAuthorizing OfficialUpdateAO Change RequestOetzel, Jerry chief financial officer Gundersen Health System 6087757914Micka, Michelle VP Finance Gundersen Health system 6087753131-531318/14/2023 3:12 PM
ContactsAuthorizing OfficialUpdateChange RequestFee, Joe P Accounting Manager Gundersen Health System 6087755558Oetzel, Jerry chief financial officer Gundersen Health System 60877579141/10/2023 3:56 PM
DetailsLast Recertification DateUpdateRecertification8/17/2021 1:48:47 PM8/30/2022 9:32:50 AM8/30/2022 9:32 AM
ContactsAuthorizing OfficialUpdateChange RequestMarsyla, Kay P Director, Reimbursement Gundersen Health System, La Crosse, WI 6087750171Fee, Joe P Accounting Manager Gundersen Health System 60877555583/29/2022 4:32 PM
DetailsLast Recertification DateUpdateRecertification8/25/2020 3:08:23 PM8/17/2021 1:48:47 PM8/17/2021 1:48 PM
Medicaid BillingNPI: NumberInsertRecertification 13765934428/25/2020 3:08 PM
Medicaid BillingNPI: StateInsertRecertification IA8/25/2020 3:08 PM
Medicaid BillingNPI: NumberInsertRecertification 13765934428/25/2020 3:08 PM
Medicaid BillingNPI: StateInsertRecertification WI8/25/2020 3:08 PM
Medicaid BillingNPI: NumberInsertRecertification 13765934428/25/2020 3:08 PM
Medicaid BillingNPI: StateInsertRecertification MN8/25/2020 3:08 PM
Medicaid BillingNPI: NumberDeleteRecertification1376593442 ( ) 8/25/2020 3:08 PM
DetailsLast Recertification DateUpdateRecertification8/20/2019 4:16:32 PM8/25/2020 3:08:23 PM8/25/2020 3:08 PM
DetailsLast Recertification DateUpdateRecertification8/21/2018 9:17:07 AM8/20/2019 4:16:32 PM8/20/2019 4:16 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 2:47:58 PM8/21/2018 9:17:07 AM8/21/2018 9:17 AM
ContactsAuthorizing OfficialUpdateChange RequestHurwitz, Laurie A. Executive Director of Revenue Cycle Gundersen Lutheran Medical Center 6087754370Marsyla, Kay P Director, Reimbursement Gundersen Health System, La Crosse, WI 60877501717/6/2018 8:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/7/2018 1:21 PM
Medicaid BillingMedicaid: NumberInsertChange Request 110129003/7/2018 1:21 PM
Medicaid BillingMedicaid: StateInsertChange Request WI3/7/2018 1:21 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/7/2018 1:21 PM
Medicaid BillingMedicaid: NumberInsertChange Request 7653476003/7/2018 1:21 PM
Medicaid BillingMedicaid: StateInsertChange Request MN3/7/2018 1:21 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/7/2018 1:21 PM
Medicaid BillingMedicaid: NumberInsertChange Request 06990173/7/2018 1:21 PM
Medicaid BillingMedicaid: StateInsertChange Request IA3/7/2018 1:21 PM
Medicaid BillingNPI: NumberInsertChange Request 13765934423/7/2018 1:21 PM
DetailsLast Recertification DateUpdateRecertification8/22/2016 12:00:00 AM11/8/2017 2:47:58 PM11/8/2017 2:47 PM
ContactsPrimary ContactUpdate Carrell, Loren Director 6087756369Carrell, Loren Director Gundersen Health System 60877563699/28/2017 3:29 PM
ContactsAuthorizing OfficialUpdate Hurwitz, Laurie A. Executive Director of Revenue Cycle 6087754370Hurwitz, Laurie A. Executive Director of Revenue Cycle Gundersen Lutheran Medical Center 60877543709/22/2017 9:18 AM
ContactsAuthorizing OfficialInsert  Hurwitz, Laurie A. Executive Director of Revenue Cycle 60877543707/11/2017 8:26 AM
ContactsSigned ByInsert  Hurwitz, Laurie A. Executive Director of Revenue Cycle 60877543705/2/2017 2:53 PM
ContactsPrimary ContactInsert  Carrell, Loren Director 60877563695/2/2017 2:53 PM
DetailsLast Recertification DateUpdate 8/6/2015 12:00:00 AM8/22/2016 12:00:00 AM8/22/2016 11:07 AM
AddressesMain AddressInsert   1836 South Ave La Crosse, WI 546018/22/2016 11:07 AM
DetailsLast Recertification DateUpdate  8/6/2015 12:00:00 AM8/6/2015 12:15 PM
DetailsEntity SubnameUpdate Main Clinic - Laboratory Clinic La Crosse / Laboratory Clinic La CrosseMain Clinic - Laboratory Clinic La Crosse12/31/2014 3:51 PM
DetailsEntity SubnameUpdate Main Clinic - Laboratory Clinic La CrosseMain Clinic - Laboratory Clinic La Crosse / Laboratory Clinic La Crosse12/19/2014 2:16 PM
DatesParticipating Approval DateUpdate  9/9/2014 12:00:00 AM9/9/2014 10:38 AM
DetailsStateUpdate PendingActive9/9/2014 10:38 AM
DatesStart DateUpdate  10/1/2014 12:00:00 AM9/9/2014 10:38 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_44325DSH520087AL9/6/2014 8:42 AM
DetailsEntity SubnameUpdate Main ClinicMain Clinic - Laboratory Clinic La Crosse9/6/2014 8:42 AM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_443257/3/2014 10:46 AM
DetailsLast Recertification DateInsert   7/3/2014 10:46 AM
DetailsGrant NumberInsert   7/3/2014 10:46 AM
Details340B IDInsert   7/3/2014 10:46 AM
DetailsIs Authorizing Official EHB DataInsert   7/3/2014 10:46 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/3/2014 10:46 AM
DetailsMedicare Provider NumberInsert  5200877/3/2014 10:46 AM
DetailsEntity NameInsert  Gundersen Lutheran Medical Center, Inc.7/3/2014 10:46 AM
DetailsProgram CodeInsert  DSH7/3/2014 10:46 AM
DetailsEntity SubnameInsert  Main Clinic7/3/2014 10:46 AM
DatesParticipating Approval DateInsert   7/3/2014 10:46 AM
DetailsStateInsert  Pending7/3/2014 10:46 AM
DatesRegistration DateInsert  7/3/2014 12:00:00 AM7/3/2014 10:46 AM
DatesSigned By DateInsert  7/3/2014 12:00:00 AM7/3/2014 10:46 AM
DatesStart DateInsert   7/3/2014 10:46 AM
TerminationsTermination CommentsInsert   7/3/2014 10:46 AM
TerminationsTermination DateInsert   7/3/2014 10:46 AM
TerminationsTermination Effective DateInsert   7/3/2014 10:46 AM
TerminationsTermination ReasonInsert   7/3/2014 10:46 AM