Covered Entity Details

RRC520098-22 UNIVERSITY OF WI HOSPITALS & CLINICS (Terminated) - information as of 5/10/2025 11:18:26 PM

Main Details

Name

UNIVERSITY OF WI HOSPITALS & CLINICS

Subdivision Name

WEST CLINIC-CLINICS - WOMEN'S HEALTH GIM

Type

Rural Referral Center

Rural

340B ID

RRC520098-22

Medicare Provider Number

520098

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/14/2020

Participating Start Date

10/1/2020

Participating Approval Date

7/28/2020

Last Recertification Date

8/28/2021

Termination Date
Termination Reason

7/1/2022
Change of covered entity type

Contacts

Authorizing Official

UW Health
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131

Primary Contact

UW Health
Jack D Temple, Senior Pharmacy Director
(608) 821-1622

Addresses

Street Address

451 JUNCTION RD
MADISON, WI 53717-2656

Billing Address

UW Health – Accounts Payable
PO Box 5448
Madison, WI 53705

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

UW Health West Clinic
451 Junction Road
Madison, WI 53717

Shipping Address 2

UW Health Pharmacy Services Building
3185 Deming Way
Middleton, WI 53562

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
RRC520098-01	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - ENDOSCOPY	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-02	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - OPHTHALMOLOGY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-03	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-SURG/OR - PRE/POST & PACU	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-04	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-IMAGING - DIAGNOSTIC	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-05	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-IMAGING - DIAGNOSTIC	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-06	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-RESPIRATORY THERAPY	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-07	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-REHAB THERAPY - ORTHOTICS PROSTHETICS	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-08	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-IMAGING - DIAGNOSTIC	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-09	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - Clinics-Certified Nurse Midwife-West Clinic	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-10	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-CLINICS - PEDIATRIC OPHTHALMOLOGY	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-11	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-IMAGING - DIAGNOSTIC	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-12	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - GENERAL INTERNAL MEDICINE	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-13	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Rehab Clinic-Middleton-CLINICS - REHAB MEDICINE	6630 UNIVERSITY AVE	MIDDLETON	WI	Terminated
RRC520098-14	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Rehab Clinic-Middleton-REHAB THERAPY - ORTHOTICS	6630 UNIVERSITY AVE	MIDDLETON	WI	Terminated
RRC520098-15	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - CARDIOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-16	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - PSYCHIATRY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-17	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WAISMAN CENTER-CLINICS - PEDS SPECIALTIES	1500 HIGHLAND AVE	MADISON	WI	Terminated
RRC520098-18	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-IMAGING - ULTRASONOGRAPHY	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-19	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-IMAGING - CT	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-20	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-IMAGING - BREAST IMAGING	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-21	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-IMAGING - BREAST IMAGING	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-22	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - WOMEN'S HEALTH GIM	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-23	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - SPECIALTY PROGRAMS	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-24	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - PEDS SPECIALTIES	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-25	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-IMAGING - DIAGNOSTIC	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-26	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-IMAGING - CT	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-27	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - SPEECH	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-28	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-CLINICS - GENERAL PEDIATRICS	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-29	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-CLINICS - CARDIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-30	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-IMAGING - MRI	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-31	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-REHAB THERAPY - ORTHOTICS	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-32	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-IMAGING - ULTRASONOGRAPHY	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-33	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-IMAGING - NUCLEAR MEDICINE	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-34	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Behavioral Health-CLINICS - BEHAVIORAL HEALTH - YOUTH AND FAMILY	122 E OLIN AVE., SUITE 275	MADISON	WI	Terminated
RRC520098-35	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - RHEUMATOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-36	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - GENERAL INTERNAL MEDICINE	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-37	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - GERIATRICS	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-38	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-SURG/OR - ANESTHESIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-39	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - RADIATION ONCOLOGY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-40	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-CLINICS - GENERAL INTERNAL MEDICINE	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-41	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-CLINICS - SPORTS MEDICINE	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-42	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-IMAGING - ULTRASONOGRAPHY	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-43	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - MOHS DERM SURGERY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-44	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - GENERAL PEDIATRICS	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-45	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-PREVENTIVE CARDIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-46	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - ALLERGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-47	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - DERMATOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-48	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLIN LABS - DERMATOPATHOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-49	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - DERMATOLOGY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-50	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - GENERAL PEDIATRICS	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-51	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - Clinics-General Gynecology-DHC	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-52	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-CLINICS - SPECIALTY PROGRAMS	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-53	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-CLINICS - MOHS DERM SURGERY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-54	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-CLINICS - GERIATRICS	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-55	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-CLINICS - ORTHOPEDICS	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-56	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-CLINICS - SPINE O/P	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-57	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-IMAGING - ULTRASONOGRAPHY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-58	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-ECHO/VASCULAR LAB	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-59	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-CLINICS - PEDS ORTHO	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-60	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - Clinics-Headache-East Clinic	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-61	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Research Park-IMAGING - MRI	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-62	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION-CLINICS - OPHTHALMOLOGY	2880 UNIVERSITY AVE	MADISON	WI	Terminated
RRC520098-63	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST CLINIC-IMAGING - DIAGNOSTIC	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-64	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - OB/GYN GENERAL	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-65	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WDI-FITCH-CLINICS - NEPHROLOGY	3034 FISH HATCHERY RD	FITCHBURG	WI	Terminated
RRC520098-66	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	1102 S PARK ST CLINICS-CLINICS - PAIN	1102 S PARK ST	MADISON	WI	Terminated
RRC520098-67	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	Unity Point_Meriter Hospital-CLINICS - GYNECOLOGY	202 S PARK ST	MADISON	WI	Terminated
RRC520098-68	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - ENDOCRINOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-69	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-SURG/OR - OPERATING ROOM	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-70	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	OAKWOOD CLINIC-CLINICS - GERIATRICS	6209 MINERAL POINT RD	MADISON	WI	Terminated
RRC520098-71	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	THE AMERICAN CENTER-EMERG MED - EMERGENCY MEDICINE	4602 EASTPARK BLVD	MADISON	WI	Terminated
RRC520098-72	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - GI/BRONCHOSCOPY PROCEDURES	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-73	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - OPHTHALMOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-74	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - GASTROENTEROLOGY	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-75	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - HEPATOLOGY	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-76	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - PERITONEAL DIALYSIS	3034 FISH HATCHERY RD	FITCHBURG	WI	Terminated
RRC520098-77	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-ECHO/VASCULAR LAB	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-78	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - DIAGNOSTIC	1675 Highland Ave	Madison	WI	Terminated
RRC520098-79	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - ULTRASONOGRAPHY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-80	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - AUDIOLOGY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-81	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - HYBRID LABORATORY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-82	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER-CLINICS - GYNEOCLOGY	750 UNIVERSITY ROW	MADISON	WI	Terminated
RRC520098-83	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	REASEARCH PARK-CLINICS - ORTHOPEDICS	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-84	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	RESEARCH PARK-CLINICS - CARDIOLOGY	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-85	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	RESEARCH PARK-ECHO/VASCULAR LAB	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-86	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - PET IMAGING	1675 Highland Ave	Madison	WI	Terminated
RRC520098-87	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - PEDS SPECIALTIES	1675 Highland Ave	Madison	WI	Terminated
RRC520098-88	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - SPEECH	1675 Highland Ave	Madison	WI	Terminated
RRC520098-89	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - RESPIRATORY THERAPY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-90	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - PEDS CARDIOLOGY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-91	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - OPERATING ROOM	1675 Highland Ave	Madison	WI	Terminated
RRC520098-92	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	RESEARCH PARK-PREVENTITIVE CARDIOLOGY	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-93	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - PRE/POST & PACU	1675 Highland Ave	Madison	WI	Terminated
RRC520098-94	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - MRI	1675 Highland Ave	Madison	WI	Terminated
RRC520098-95	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - CLINICS - RADIATION ONCOLOGY-PARATHERAPY	5249 E TERRACE DR	MADISON	WI	Terminated
RRC520098-96	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	WEST CLINIC-CLINICS - VASCULAR SURGERY	451 JUNCTION RD	MADISON	WI	Terminated
RRC520098-97	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - ANESTHESIOLOGY	1675 Highland Ave	Madison	WI	Terminated
RRC520098-98	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - REHAB THERAPY - PEDIATRIC FITNESS CLINIC	621 SCIENCE DR	MADISON	WI	Terminated
RRC520098-99	Child	RRC	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY OF WISCONSIN HOSPITALS A - MULTI-D - GI ONCOLOGY	750 UNIVERSITY ROW	MADISON	WI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2022 12:00:00 AM	4/14/2022 7:12 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	4/14/2022 7:12 AM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2022 12:00:00 AM	4/14/2022 7:12 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2022 12:00:00 AM	4/14/2022 7:12 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	4/14/2022 7:12 AM
Details	Last Recertification Date	Update	Recertification		8/28/2021 11:23:47 AM	8/28/2021 11:23 AM
Details	Entity Subname	Update	Change Request	UNIVERSITY OF WISCONSIN HOSPITALS A - Clinics-Women’s Health Internal Medicine-West Clinic	WEST CLINIC-CLINICS - WOMEN'S HEALTH GIM	1/14/2021 4:30 PM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Primary Contact	Update	Change Request	Schrant, Heather N Pharmacy Director UW Health 6088906453	Temple, Jack D Senior Pharmacy Director UW Health 6088211622	8/27/2020 12:42 PM
Contacts	Signed By	Insert	New Registration		Flannery, Robert W Senior VP/Chief Financial Officer UW Health 6082657131	7/28/2020 10:13 AM
Details	340B ID	Update	New Registration		RRC520098-22	7/28/2020 10:13 AM
Details	Entity Subname	Update	New Registration	UNIVERSITY OF WISCONSIN HOSPITALS A	UNIVERSITY OF WISCONSIN HOSPITALS A - Clinics-Women’s Health Internal Medicine-West Clinic	7/28/2020 10:13 AM
Dates	Participating Approval Date	Update	New Registration		7/28/2020 10:13:22 AM	7/28/2020 10:13 AM
Details	State	Update	New Registration	Pending	Approved	7/28/2020 10:13 AM
Dates	Signed By Date	Update	New Registration		7/14/2020 4:25:59 PM	7/28/2020 10:13 AM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/28/2020 10:13 AM
Addresses	Main Address	Insert	New Registration		451 JUNCTION RD MADISON, WI 53717-2656	7/14/2020 12:13 PM
Addresses	Billing Address	Insert	New Registration		UW Health – Accounts Payable PO Box 5448 Madison, WI 53705	7/14/2020 12:13 PM
Addresses	Shipping Address	Insert	New Registration		UW Health West Clinic 451 Junction Road Madison, WI 53717	7/14/2020 12:13 PM
Addresses	Shipping Address	Insert	New Registration		UW Health Pharmacy Services Building 3185 Deming Way Middleton, WI 53562	7/14/2020 12:13 PM
Contacts	Primary Contact	Insert	New Registration		Schrant, Heather N Pharmacy Director UW Health 6088906453	7/14/2020 12:13 PM
Contacts	Authorizing Official	Insert	New Registration		Flannery, Robert W Senior VP/Chief Financial Officer UW Health 6082657131	7/14/2020 12:13 PM
Details	Last Recertification Date	Insert	New Registration			7/14/2020 12:13 PM
Details	Grant Number	Insert	New Registration			7/14/2020 12:13 PM
Details	340B ID	Insert	New Registration			7/14/2020 12:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2020 12:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2020 12:13 PM
Details	Medicare Provider Number	Insert	New Registration		520098	7/14/2020 12:13 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF WI HOSPITALS & CLINICS	7/14/2020 12:13 PM
Details	Program Code	Insert	New Registration		RRC	7/14/2020 12:13 PM
Details	Entity Subname	Insert	New Registration		UNIVERSITY OF WISCONSIN HOSPITALS A	7/14/2020 12:13 PM
Dates	Participating Approval Date	Insert	New Registration			7/14/2020 12:13 PM
Details	State	Insert	New Registration		Pending	7/14/2020 12:13 PM
Dates	Registration Date	Insert	New Registration		7/14/2020 12:13:54 PM	7/14/2020 12:13 PM
Dates	Signed By Date	Insert	New Registration			7/14/2020 12:13 PM
Dates	Start Date	Insert	New Registration			7/14/2020 12:13 PM
Terminations	Termination Comments	Insert	New Registration			7/14/2020 12:13 PM
Terminations	Termination Date	Insert	New Registration			7/14/2020 12:13 PM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2020 12:13 PM
Terminations	Termination Reason	Insert	New Registration			7/14/2020 12:13 PM