Covered Entity Details

DSH520089V Meriter Health Services (Active) - information as of 6/25/2025 12:54:51 AM

Main Details

Name

Meriter Health Services

Subdivision Name

UnityPoint Health-Meriter-McKee Clinic-Internal Medicine - Internal Medicine

Type

Disproportionate Share Hospital

Rural

340B ID

DSH520089V

Medicare Provider Number

520089

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2021

Participating Start Date

1/1/2022

Participating Approval Date

11/9/2021

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

UnityPoint Health-Meriter
Beth Erdman, CFO
(608) 417-5800

Primary Contact

Meriter Health Services
Nikita Pianzov, Pharmacy 340b Analyst
(608) 417-6708

Addresses

Street Address

3102 Meriter Way
Madison, WI 53719

Billing Address

Meriter Health Services
202 S Park St
Madison, WI 53715

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

Meriter Health Services
202 S Park St
Madison, WI 53715

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
DSH520089A	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-DeForest-Windsor Clinic-Family Medicine	4200 Savannah Drive	DeForest	WI	Active
DSH520089AA	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Monona Clinic-ENT - ENT	6408 Copps Avenue	Monona	WI	Active
DSH520089AB	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Monona Clinic-Rheumatology - Rheumatology	6408 Copps Avenue	Monona	WI	Active
DSH520089B	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Deming Way Clinic	2275 Deming Way	Middleton	WI	Terminated
DSH520089C	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Fitchburg Clinic-Family Medicine	2690 Research Park Drive	Fitchburg	WI	Active
DSH520089D	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-McKee Clinic-Family Medicine	3102 Meriter Way	Madison	WI	Active
DSH520089E	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Middleton Clinic-Family Medicine	7780 Elmwood Avenue	Middleton	WI	Active
DSH520089F	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Monona Clinic-Family Medicine	6408 Copps Avenue	Monona	WI	Active
DSH520089G	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-West Washington Clinic-Rheumatology	345 W Washington Ave	Madison	WI	Active
DSH520089H	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Heart & Vascular Institute	2601 W Beltline Hwy	Madison	WI	Terminated
DSH520089J	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-NewStart	1015 Gammon Ln	Madison	WI	Active
DSH520089K	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Stoughton Clinic-Family Medicine	100 Silverado Drive	Stoughton	WI	Active
DSH520089L	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Dermatology Clinic	2275 Deming Way	Middleton	WI	Terminated
DSH520089M	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Orthopedic Clinic	2275 Deming Way	Middleton	WI	Terminated
DSH520089N	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Vein Center	2601 W Beltline Hwy	Madison	WI	Terminated
DSH520089P	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-DeForest-Windsor Clinic-Endocrinology - Endocrinology	4200 Savannah Drive	DeForest	WI	Active
DSH520089Q	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-West Washington Clinic-Family Medicine - Family Medicine	345 W Washington Ave	Madison	WI	Active
DSH520089R	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-West Washington Clinic-Endocrinology - Endocrinology	345 W Washington Ave	Madison	WI	Active
DSH520089S	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Stoughton Clinic-Internal Medicine - Internal Medicine	100 Silverado Drive	Stoughton	WI	Terminated
DSH520089T	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-West Washington Clinic-Pediatrics - Pediatrics	345 W Washington Ave	Madison	WI	Terminated
DSH520089U	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Middleton Clinic-Internal Medicine - Internal Medicine	7780 Elmwood Avenue	Middleton	WI	Active
DSH520089V	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-McKee Clinic-Internal Medicine - Internal Medicine	3102 Meriter Way	Madison	WI	Active
DSH520089W	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-McKee Clinic-Endocrinology - Endocrinology	3102 Meriter Way	Madison	WI	Active
DSH520089X	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-McKee Clinic-Internal Medicine Pediatrics - Internal Medicine Pediatrics	3102 Meriter Way	Madison	WI	Active
DSH520089Y	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Monona Clinic-Internal Medicine - Internal Medicine	6408 Copps Avenue	Monona	WI	Active
DSH520089Z	Child	DSH	Meriter Health Services	UnityPoint Health-Meriter-Monona Clinic-Pediatrics - Pediatrics	6408 Copps Avenue	Monona	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 5:17:57 PM	9/4/2024 2:55:49 PM	9/4/2024 2:55 PM
Contacts	Primary Contact	Update	PC Change Request	Totten, Jeffrey Eugene 340B Program Administrator Meriter Health Services 6084176708	Pianzov, Nikita Pharmacy 340b Analyst Meriter Health Services 6084176708	1/3/2024 11:17 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:18:17 PM	8/31/2023 5:17:57 PM	8/31/2023 5:17 PM
Addresses	Shipping Address	Insert	Change Request		Meriter Health Services 202 S Park St Madison, WI 53715	12/21/2022 7:58 AM
Contacts	Primary Contact	Update	Profile Change Request	Totten, Jeffrey Eugene 340B Program Administrator Meriter Health Services 6087203257	Totten, Jeffrey Eugene 340B Program Administrator Meriter Health Services 6084176708	9/20/2022 10:20 AM
Details	Last Recertification Date	Update	Recertification		9/6/2022 12:18:17 PM	9/6/2022 12:18 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Erdman, Beth CFO UnityPoint Health-Meriter 6084175800	11/9/2021 12:41 PM
Details	340B ID	Update	New Registration		DSH520089V	11/9/2021 12:41 PM
Details	Entity Name	Update	New Registration	MERITER HOSPITAL INC.	Meriter Health Services	11/9/2021 12:41 PM
Details	Entity Subname	Update	New Registration	UnityPoint Health-Meriter-McKee Clinic-Internal Medicine	UnityPoint Health-Meriter-McKee Clinic-Internal Medicine - Internal Medicine	11/9/2021 12:41 PM
Dates	Participating Approval Date	Update	New Registration		11/9/2021 12:41:47 PM	11/9/2021 12:41 PM
Details	State	Update	New Registration	Pending	Approved	11/9/2021 12:41 PM
Dates	Signed By Date	Update	New Registration		11/8/2021 11:10:22 AM	11/9/2021 12:41 PM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/9/2021 12:41 PM
Addresses	Main Address	Insert	New Registration		3102 Meriter Way Madison, WI 53719	10/13/2021 12:03 PM
Addresses	Billing Address	Insert	New Registration		Meriter Health Services 202 S Park St Madison, WI 53715	10/13/2021 12:03 PM
Contacts	Primary Contact	Insert	New Registration		Totten, Jeffrey Eugene 340B Program Administrator Meriter Health Services 6087203257	10/13/2021 12:03 PM
Contacts	Authorizing Official	Insert	New Registration		Erdman, Beth CFO UnityPoint Health-Meriter 6084175800	10/13/2021 12:03 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Grant Number	Insert	New Registration			10/13/2021 12:03 PM
Details	340B ID	Insert	New Registration			10/13/2021 12:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2021 12:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2021 12:03 PM
Details	Medicare Provider Number	Insert	New Registration		520089	10/13/2021 12:03 PM
Details	Entity Name	Insert	New Registration		MERITER HOSPITAL INC.	10/13/2021 12:03 PM
Details	NOFO Number	Insert	New Registration			10/13/2021 12:03 PM
Details	Program Code	Insert	New Registration		DSH	10/13/2021 12:03 PM
Details	Entity Subname	Insert	New Registration		UnityPoint Health-Meriter-McKee Clinic-Internal Medicine	10/13/2021 12:03 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2021 12:03 PM
Details	State	Insert	New Registration		Pending	10/13/2021 12:03 PM
Dates	Registration Date	Insert	New Registration		10/13/2021 12:03:16 PM	10/13/2021 12:03 PM
Dates	Signed By Date	Insert	New Registration			10/13/2021 12:03 PM
Dates	Start Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2021 12:03 PM