340B Drug Pricing Program Database


RRC520004-11 MCHS FRANCISCAN HEALTHCARE INC (Terminated) - information as of 5/14/2025 10:32:45 PM

Main Details
MCHS FRANCISCAN HEALTHCARE INC
Mayo Clinic Health System—Franciscan Healthcare in Holmen—Pediatrics
Rural Referral Center
Yes
RRC520004-11
520004


Additional Details
Terminated
4/12/2021
7/1/2021
5/17/2021
9/8/2021

7/1/2022
Hospital Outpatient facility no longer eligible

Contacts

Mayo Clinic Health System Northwest Wisconsin
Michael Morrey, Regional Chair--Administration NWWI
(715) 464-0022

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

Addresses

1303 SOUTH MAIN STREET
HOLMEN, WI 54636-8927

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 7/1/2018; Terminated 7/1/2019; Reinstated 7/1/2021.05/17/2021
Medicaid Billing

No
Shipping Addresses

MAYO CLINIC HEALTH SYSTEM LA CROSSE HOSPITAL PHARMACY
700 WEST AVE SOUTH
LA CROSSE, WI 54601

MAYO CLINIC HEALTH SYSTEM HOLMEN PHARMACY
1303 S MAIN ST
HOLMEN, WI 54636

MAYO CLINIC HEALTH SYSTEM SKEMP PHARMACY
800 WEST AVE SOUTH
SUITE 101
LA CROSSE, WI 54601

MAYO CLINIC HEALTH SYSTEM ONALASKA PHARMACY
191 THEATER ROAD
SUITE 200
ONALASKA, WI 54650
Contract Pharmacies
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
RRC520004-01ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - FRANCIS - LA CRESCENT CLINIC LAB (RRC)524 N ELM STLA CRESCENTMNTerminated
RRC520004-03ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Radiology191 THEATER RDONALASKAWIActive
RRC520004-04ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Holmen—Radiology1303 S MAIN STHOLMENWIActive
RRC520004-05ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Holmen—Ultrasound1303 S MAIN STHOLMENWIActive
RRC520004-06ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Center for Health and Healing191 THEATER RDONALASKAWIActive
RRC520004-07ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Pediatrics191 THEATER RDONALASKAWIActive
RRC520004-08ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Caledonia—Radiology701 N SPRAGUE STCALEDONIAMNActive
RRC520004-09ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - ONALASKA FAMILY MEDICINE (RRC)191 THEATER RDONALASKAWITerminated
RRC520004-10ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - ONALASKA URGENT CARE (RRC)1600 MAIN STREETONALASKAWITerminated
RRC520004-11ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Holmen—Pediatrics1303 SOUTH MAIN STREETHOLMENWITerminated
RRC520004-12ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - FRANCIS - LA CRESCENT CLINIC RADIOLOGY (RRC)524 N ELM STLA CRESCENTMNTerminated
RRC520004-13ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Echocardiography191 THEATER RDONALASKAWIActive
RRC520004-14ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Family Medicine191 THEATER RDONALASKAWIActive
RRC520004-15ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Caledonia—Family Medicine701 N SPRAGUE STCALEDONIAMNActive
RRC520004-16ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - FRANCIS - LA CRESCENT FAMILY MEDICINE (RRC)524 N ELM STLA CRESCENTMNTerminated
RRC520004-17ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - ONALASKA CLINIC LAB (RRC)191 THEATER RDONALASKAWITerminated
RRC520004-18ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Holmen—Family Medicine1303 S MAIN STHOLMENWIActive
RRC520004-19ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - ONALASKA WOMEN'S HEALTH SERVICES (RRC)191 THEATER RDONALASKAWITerminated
RRC520004-20ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - FRANCIS - CALEDONIA CLINIC LAB (RRC)701 N SPRAGUE STCALEDONIAMNTerminated
RRC520004-21ChildRRCMayo Clinic Health System-Franciscan Healthcare La CrosseMAYO CLINIC HEALTH SYSTEM - HOLMEN CLINIC LAB (RRC)1303 SOUTH MAIN STREETHOLMENWITerminated
RRC520004-22ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Ultrasound191 THEATER RDONALASKAWIActive
RRC520004-23ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Caledonia—Podiatry701 N SPRAGUE STCALEDONIAMNActive
RRC520004-24ChildRRCMCHS FRANCISCAN HEALTHCARE INCMayo Clinic Health System—Franciscan Healthcare in Onalaska—Internal Medicine191 THEATER RDONALASKAWIActive
RRC520004-25ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Clinical Dietetics800 WEST AVE SLa CrosseWIActive
RRC520004-26ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska— - Urgent Care191 THEATER RDOnalaskaWIActive
RRC520004-27ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse— - Pediatric Specialties800 WEST AVE SLa CrosseWIActive
RRC520004-28ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Pulmonology800 WEST AVE SLa CrosseWIActive
RRC520004-29ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Palliative Care800 WEST AVE SLa CrosseWIActive
RRC520004-30ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Physical Medicine & Rehabilitation800 WEST AVE SLa CrosseWIActive
RRC520004-31ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Anti-Coagulation Clinic800 WEST AVE SLa CrosseWIActive
RRC520004-32ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Orthopedics800 WEST AVE SLa CrosseWIActive
RRC520004-33ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Pulmonary Medicine800 WEST AVE SLa CrosseWIActive
RRC520004-34ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Surgery800 WEST AVE SLa CrosseWIActive
RRC520004-35ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska—Ophthalmology191 THEATER RDOnalaskaWIActive
RRC520004-36ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Ophthalmology800 WEST AVE SLa CrosseWIActive
RRC520004-37ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska—Physical Medicine & Rehabilitation191 THEATER RDOnalaskaWIActive
RRC520004-38ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Endocrinology800 WEST AVE SLa CrosseWIActive
RRC520004-39ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Mobile Imaging800 WEST AVE SLa CrosseWITerminated
RRC520004-40ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Cardiology800 WEST AVE SLa CrosseWIActive
RRC520004-41ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Gastroenterology and Hepatology800 WEST AVE SLa CrosseWIActive
RRC520004-42ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Plastic Surgery800 WEST AVE SLa CrosseWIActive
RRC520004-43ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Nephrology and Hypertension800 WEST AVE SLa CrosseWIActive
RRC520004-44ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Caledonia—Ophthalmology701 N SPRAGUE STCaledoniaMNActive
RRC520004-45ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Oncology800 WEST AVE SLa CrosseWIActive
RRC520004-46ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Neurosurgery800 WEST AVE SLa CrosseWIActive
RRC520004-47ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Urology800 WEST AVE SLa CrosseWIActive
RRC520004-48ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Physical Therapy800 WEST AVE SLa CrosseWIActive
RRC520004-49ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Holmen—Physical Medicine & Rehabilitation1303 S MAIN STHolmenWIActive
RRC520004-50ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Obstetrics and Gynecology800 WEST AVE SLa CrosseWIActive
RRC520004-51ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska—Sports Medicine191 THEATER RDOnalaskaWIActive
RRC520004-52ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska—Rheumatology191 THEATER RDOnalaskaWIActive
RRC520004-53ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Ultrasound800 WEST AVE SLa CrosseWITerminated
RRC520004-54ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—ENT800 WEST AVE SLa CrosseWIActive
RRC520004-55ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Neurology800 WEST AVE SLa CrosseWIActive
RRC520004-56ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Dermatology800 WEST AVE SLa CrosseWIActive
RRC520004-57ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Radiology800 WEST AVE SLa CrosseWIActive
RRC520004-58ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in Onalaska—MRI191 THEATER RDOnalaskaWITerminated
RRC520004-59ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Family Medicine800 WEST AVE SLa CrosseWIActive
RRC520004-60ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Infectious Diseases800 WEST AVE SLa CrosseWIActive
RRC520004-61ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Pediatrics800 WEST AVE SLa CrosseWIActive
RRC520004-62ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse—Allergy and Immunology800 WEST AVE SLa CrosseWIActive
RRC520004-63ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse— - Center for Women's Health800 WEST AVE SLa CrosseWITerminated
RRC520004-64ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse— - Geriatrics800 WEST AVE SLa CrosseWIActive
RRC520004-65ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS—Franciscan Healthcare in La Crosse— - Diabetes Education Center800 WEST AVE SLa CrosseWIActive
RRC520004-66ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS-Franciscan Healthcare in La Crosse - Center for Breast Care800 WEST AVE SLa CrosseWIActive
RRC520004-67ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Holmen Clinic - Allergy and Immunology1303 S Main StHolmenWIActive
RRC520004-68ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Orthopedic Surgery191 Theater RdOnalaskaWIActive
RRC520004-69ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Holmen Clinic - Anticoagulation1303 S Main StHolmenWITerminated
RRC520004-70ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Physical Medicine191 Theater RdOnalaskaWIActive
RRC520004-71ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Holmen Clinic - Nutrition1303 S Main StHolmenWIActive
RRC520004-72ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Caledonia Clinic - Anticoagulation701 N Sprague StCalendoniaMNActive
RRC520004-73ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Pulmonary Medicine191 Theater RdOnalaskaWIActive
RRC520004-74ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - Colon and Rectal Surgery800 West Ave SLa CrosseWIActive
RRC520004-75ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Holmen Clinic - Obstetrics and Gynecology1303 S Main StHolmenWIActive
RRC520004-76ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Pediatric Specilties191 Theater RoadOnalaskaWIActive
RRC520004-77ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Otorhinolaryngology191 Theater RdOnalaskaWIActive
RRC520004-78ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - General Surgery800 West Ave SLa CrosseWIActive
RRC520004-79ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - Psychiatry and Psychology800 West Ave SLa CrosseWIActive
RRC520004-80ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Dermatology191 Theater RdOnalaskaWIActive
RRC520004-81ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Cardiovascular Disease191 Theater RdOnalaskaWIActive
RRC520004-82ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - Family Medicine815 10th StLa CrosseWIActive
RRC520004-83ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Urology191 Theater RdOnalaskaWIActive
RRC520004-84ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - Pain Medicine800 West Ave SLa CrosseWIActive
RRC520004-85ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI La Crosse Campus Clinic - Cardiovascular Video Medicine800 West Ave SLa CrosseWIActive
RRC520004-86ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Allergy and Immunology191 Theater RdOnalaskaWIActive
RRC520004-87ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Holmen Clinic - Orthopedic Surgery1303 S Main StHolmenWIActive
RRC520004-88ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Nutrition191 Theater RdOnalaskaWIActive
RRC520004-89ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Anticoagulation191 Theater RdOnalaskaWIActive
RRC520004-90ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Onalaska Clinic - Obstetrics and Gynecology191 Theater RdOnalaskaWIActive
RRC520004-91ChildRRCMCHS FRANCISCAN HEALTHCARE INCMCHS WI Caledonia Clinic - Nutrition701 N Sprague StCalendoniaMNActive
RRC520004-92ChildRRCMCHS FRANCISCAN HEALTHCARE INCMAYO CLINIC HEALTH SYSTEM - Vascular Surgery800 WEST AVE SLA CROSSEWIActive
RRC520004-93ChildRRCMCHS FRANCISCAN HEALTHCARE INCMAYO CLINIC HEALTH SYSTEM - General Surgery191 THEATER RDONALASKAWIActive
RRC520004-94ChildRRCMCHS FRANCISCAN HEALTHCARE INCMAYO CLINIC HEALTH SYSTEM - CT191 THEATER RDONALASKAWIActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated7/1/2022 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 7/1/2021 12:00:00 AM5/17/2022 8:31 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated5/17/2022 8:31 AM
TerminationsTermination DateUpdateTermination Request 7/1/2022 12:00:00 AM5/17/2022 8:31 AM
TerminationsTermination Effective DateUpdateTermination Request 7/1/2021 12:00:00 AM5/17/2022 8:31 AM
TerminationsTermination ReasonUpdateTermination Request Hospital Outpatient facility no longer eligible5/17/2022 8:31 AM
ContactsPrimary ContactUpdateProfile Change RequestBuda, Alicia M. E. Operations Manager Mayo Clinic 5072553648Buda, Alicia Operations Manager Mayo Clinic 507293325112/21/2021 2:39 PM
ContactsPrimary ContactUpdateGroup Change RequestKlaassen, Amanda Senior Business Analyst Mayo Clinic 5072661963Buda, Alicia M. E. Operations Manager Mayo Clinic 50725536489/17/2021 11:44 AM
DetailsLast Recertification DateUpdateRecertification 9/8/2021 10:44:57 AM9/8/2021 10:44 AM
DetailsStateUpdate ApprovedActive7/1/2021 12:01 AM
DetailsEntity SubnameUpdateChange RequestMAYO CLINIC HEALTH SYSTEM - Holmen Pediatrics Clinic (RRC)Mayo Clinic Health System—Franciscan Healthcare in Holmen—Pediatrics5/21/2021 11:23 AM
AddressesShipping AddressDeleteReinstatementMAYO CLINIC HEALTH SYSTEM ST. FRANCIS 700 WEST AVE SOUTH SUITE 101 LA CROSSE, WI 54601 5/17/2021 1:55 PM
ContactsAuthorizing OfficialUpdateReinstatementHansen, Julie Schaus CFO-Wisconsin Mayo Clinic Health System 7158385270Morrey, Michael Regional Chair--Administration NWWI Mayo Clinic Health System Northwest Wisconsin 71546400225/17/2021 1:55 PM
ContactsSigned ByUpdateReinstatementKruse, Joseph Regional Chair of Administration SWWI Mayo Clinic 6083929740Morrey, Michael Regional Chair--Administration NWWI Mayo Clinic Health System Northwest Wisconsin 71546400225/17/2021 1:55 PM
ContactsPrimary ContactUpdateReinstatementHovell, Jenni 340B Operations Manager Mayo Clinic 5072845061Klaassen, Amanda Senior Business Analyst Mayo Clinic 50726619635/17/2021 1:55 PM
DetailsLast Recertification DateUpdateReinstatement8/29/2018 4:13:06 PM 5/17/2021 1:55 PM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement5/31/2019 12:00:00 AM 5/17/2021 1:55 PM
DetailsEntity NameUpdateReinstatementMayo Clinic Health System-Franciscan Healthcare La CrosseMCHS FRANCISCAN HEALTHCARE INC5/17/2021 1:55 PM
DatesParticipating Approval DateUpdateReinstatement5/10/2018 9:38:48 AM5/17/2021 1:55:16 PM5/17/2021 1:55 PM
DetailsStateUpdateReinstatementTerminatedApproved5/17/2021 1:55 PM
DatesRegistration DateUpdateReinstatement4/9/2018 2:24:55 PM4/12/2021 9:22:28 PM5/17/2021 1:55 PM
DatesSigned By DateUpdateReinstatement4/10/2018 3:49:30 PM4/13/2021 12:05:08 PM5/17/2021 1:55 PM
DatesStart DateUpdateReinstatement7/1/2018 12:00:00 AM7/1/2021 12:00:00 AM5/17/2021 1:55 PM
TerminationsTermination DateUpdateReinstatement7/1/2019 12:00:00 AM 5/17/2021 1:55 PM
TerminationsTermination Effective DateUpdateReinstatement5/31/2019 12:00:00 AM 5/17/2021 1:55 PM
TerminationsTermination ReasonUpdateReinstatementDSH percentage below statutory minimum 5/17/2021 1:55 PM
DetailsComments PublicInsertReinstatement Participated starting 7/1/2018; Terminated 7/1/2019; Reinstated 7/1/2021.5/17/2021 12:11 PM
DetailsStateUpdate To Be TerminatedTerminated7/1/2019 12:05 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 5/31/2019 12:00:00 AM6/3/2019 12:46 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated6/3/2019 12:46 PM
TerminationsTermination DateUpdateTermination Request 7/1/2019 12:00:00 AM6/3/2019 12:46 PM
TerminationsTermination Effective DateUpdateTermination Request 5/31/2019 12:00:00 AM6/3/2019 12:46 PM
TerminationsTermination ReasonUpdateTermination Request DSH percentage below statutory minimum6/3/2019 12:46 PM
ContactsAuthorizing OfficialUpdateChange RequestKruse, Joseph Regional Chair of Administration SWWI Mayo Clinic 6083929740Hansen, Julie Schaus CFO-Wisconsin Mayo Clinic Health System 715838527011/28/2018 10:39 AM
DetailsEntity NameUpdateRecertificationLa Crosse HospitalMayo Clinic Health System-Franciscan Healthcare La Crosse9/4/2018 1:02 PM
AddressesShipping AddressInsertRecertification MAYO CLINIC HEALTH SYSTEM SKEMP PHARMACY 800 WEST AVE SOUTH SUITE 101 LA CROSSE, WI 546018/29/2018 4:13 PM
AddressesShipping AddressInsertRecertification MAYO CLINIC HEALTH SYSTEM ST. FRANCIS 700 WEST AVE SOUTH SUITE 101 LA CROSSE, WI 546018/29/2018 4:13 PM
AddressesShipping AddressInsertRecertification MAYO CLINIC HEALTH SYSTEM ONALASKA PHARMACY 191 THEATER ROAD SUITE 200 ONALASKA, WI 546508/29/2018 4:13 PM
DetailsLast Recertification DateUpdateRecertification 8/29/2018 4:13:06 PM8/29/2018 4:13 PM
DetailsStateUpdate ApprovedActive7/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Kruse, Joseph Regional Chair of Administration SWWI Mayo Clinic 60839297405/10/2018 9:38 AM
Details340B IDUpdateNew Registration RRC520004-115/10/2018 9:38 AM
DetailsEntity SubnameUpdateNew RegistrationMAYO CLINIC HEALTH SYSTEMMAYO CLINIC HEALTH SYSTEM - Holmen Pediatrics Clinic (RRC)5/10/2018 9:38 AM
DatesParticipating Approval DateUpdateNew Registration 5/10/2018 9:38:48 AM5/10/2018 9:38 AM
DetailsStateUpdateNew RegistrationPendingApproved5/10/2018 9:38 AM
DatesSigned By DateUpdateNew Registration 4/10/2018 3:49:30 PM5/10/2018 9:38 AM
DatesStart DateUpdateNew Registration 7/1/2018 12:00:00 AM5/10/2018 9:38 AM
AddressesMain AddressInsertNew Registration  1303 SOUTH MAIN STREET HOLMEN, WI 54636-89274/9/2018 2:24 PM
AddressesShipping AddressInsertNew Registration MAYO CLINIC HEALTH SYSTEM LA CROSSE HOSPITAL PHARMACY 700 WEST AVE SOUTH LA CROSSE, WI 546014/9/2018 2:24 PM
AddressesShipping AddressInsertNew Registration MAYO CLINIC HEALTH SYSTEM HOLMEN PHARMACY 1303 S MAIN ST HOLMEN, WI 546364/9/2018 2:24 PM
ContactsPrimary ContactInsertNew Registration Hovell, Jenni 340B Operations Manager Mayo Clinic 50728450614/9/2018 2:24 PM
ContactsAuthorizing OfficialInsertNew Registration Kruse, Joseph Regional Chair of Administration SWWI Mayo Clinic 60839297404/9/2018 2:24 PM
DetailsLast Recertification DateInsertNew Registration  4/9/2018 2:24 PM
DetailsGrant NumberInsertNew Registration  4/9/2018 2:24 PM
Details340B IDInsertNew Registration  4/9/2018 2:24 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/9/2018 2:24 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/9/2018 2:24 PM
DetailsMedicare Provider NumberInsertNew Registration 5200044/9/2018 2:24 PM
DetailsEntity NameInsertNew Registration La Crosse Hospital4/9/2018 2:24 PM
DetailsProgram CodeInsertNew Registration RRC4/9/2018 2:24 PM
DetailsEntity SubnameInsertNew Registration MAYO CLINIC HEALTH SYSTEM4/9/2018 2:24 PM
DatesParticipating Approval DateInsertNew Registration  4/9/2018 2:24 PM
DetailsStateInsertNew Registration Pending4/9/2018 2:24 PM
DatesRegistration DateInsertNew Registration 4/9/2018 2:24:55 PM4/9/2018 2:24 PM
DatesSigned By DateInsertNew Registration  4/9/2018 2:24 PM
DatesStart DateInsertNew Registration  4/9/2018 2:24 PM
TerminationsTermination CommentsInsertNew Registration  4/9/2018 2:24 PM
TerminationsTermination DateInsertNew Registration  4/9/2018 2:24 PM
TerminationsTermination Effective DateInsertNew Registration  4/9/2018 2:24 PM
TerminationsTermination ReasonInsertNew Registration  4/9/2018 2:24 PM