Covered Entity Details

CAH521340-14 Mayo Clinic Health System - Red Cedar (Active) - information as of 4/25/2025 12:01:42 AM

Main Details

Name

Mayo Clinic Health System - Red Cedar

Subdivision Name

MCHS WI Orthopedic and Rehab Center - Dermatology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521340-14

Medicare Provider Number

521340

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/6/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/11/2023

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

2407 Stout Rd
Menonomonie, WI 54751

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--Red Cedar in Menomonie Outpatient Pharmacy
2321 Stout Road
Menomonie, WI 54751

Shipping Address 2

Mayo Clinic Health System--Red Cedar in Menomonie Hospital Pharmacy
2321 Stout Road
Menomonie, WI 54751

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
CAH521340-01	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS- Red Cedar in Glenwood City: Family Medicine	219 East Oak St.	Glenwood City	WI	Active
CAH521340-02	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS- Red Cedar in Elmwood- Family Medicine	236 East Springer Avenue	Elmwood	WI	Terminated
CAH521340-03	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Glenwood City - Physical Medicine and Rehabilitation	219 E Oak St	Glenwood City	WI	Active
CAH521340-04	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Glenwood City - Radiology	219 E Oak St	Glenwood City	WI	Terminated
CAH521340-05	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS-Red Cedar in Elmwood - Internal Medicine	236 E Springer Ave	Elmwood	WI	Terminated
CAH521340-06	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Occupational Medicine	2407 Stout Rd	Menomonie	WI	Active
CAH521340-07	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Orthopedics	2407 Stout Rd	Menomonie	WI	Active
CAH521340-08	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Physical Medicine and Rehabilitation	2407 Stout Rd	Menomonie	WI	Active
CAH521340-09	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Physical Therapy	2407 Stout Rd	Menomonie	WI	Active
CAH521340-10	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar - Behavioral Health	2411 Stout Rd	Menomonie	WI	Active
CAH521340-11	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS Red Cedar Orthopedic & Rehabilitation Center - Pain Medicine	2407 Stout Road	Menomonie	WI	Active
CAH521340-12	Child	CAH	Mayo Clinic Health System - Red Cedar	Orthopedic & Rehabilitation Center - Family Medicine	2407 Stout Road	Menomonie	WI	Terminated
CAH521340-13	Child	CAH	Mayo Clinic Health System - Red Cedar	Menomonie - Neurological Surgery	2407 Stout Road	Menomonie	WI	Active
CAH521340-14	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS WI Orthopedic and Rehab Center - Dermatology	2407 Stout Rd	Menonomonie	WI	Active
CAH521340-15	Child	CAH	Mayo Clinic Health System - Red Cedar	MCHS WI Menomonie 2403 Building - Psychiatry and Psychology	2403 Stout Road	Menomonie	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 12:55 PM
Details	Last Recertification Date	Update	Recertification		8/13/2024 8:05:52 AM	8/13/2024 8:05 AM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Addresses	Main Address	Insert	New Registration		2407 Stout Rd Menonomonie, WI 54751	10/11/2023 12:14 PM
Contacts	Signed By	Insert	New Registration		Eberle, Michele Vice Chair-Administration NWWI Mayo Clinic 7155686113	10/11/2023 12:14 PM
Details	340B ID	Update	New Registration		CAH521340-14	10/11/2023 12:14 PM
Details	Entity Name	Update	New Registration	MCHS-RED CEDAR	Mayo Clinic Health System - Red Cedar	10/11/2023 12:14 PM
Details	Entity Subname	Update	New Registration	MCHS WI Orthopedic and Rehab Center	MCHS WI Orthopedic and Rehab Center - Dermatology	10/11/2023 12:14 PM
Dates	Participating Approval Date	Update	New Registration		10/11/2023 12:14:38 PM	10/11/2023 12:14 PM
Details	State	Update	New Registration	Pending	Approved	10/11/2023 12:14 PM
Dates	Signed By Date	Update	New Registration		10/10/2023 3:57:40 PM	10/11/2023 12:14 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/11/2023 12:14 PM
Addresses	Main Address	Insert	New Registration		2407 Stout Rd Menonomonie, WI 54751	10/6/2023 3:44 PM
Addresses	Billing Address	Insert	New Registration		Mayo Clinic Health System - Red Cedar 2321 Stout Road Menomonie, WI 54751	10/6/2023 3:44 PM
Addresses	Shipping Address	Insert	New Registration		Mayo Clinic Health System--Red Cedar in Menomonie Outpatient Pharmacy 2321 Stout Road Menomonie, WI 54751	10/6/2023 3:44 PM
Addresses	Shipping Address	Insert	New Registration		Mayo Clinic Health System--Red Cedar in Menomonie Hospital Pharmacy 2321 Stout Road Menomonie, WI 54751	10/6/2023 3:44 PM
Contacts	Authorizing Official	Insert	New Registration		Eberle, Michele Vice Chair-Administration NWWI Mayo Clinic 7155686113	10/6/2023 3:44 PM
Contacts	Primary Contact	Insert	New Registration		Buda, Alicia Operations Manager Mayo Clinic 5072933251	10/6/2023 3:44 PM
Details	Assistance Received From Date	Insert	New Registration			10/6/2023 3:44 PM
Details	Assistance Received To Date	Insert	New Registration			10/6/2023 3:44 PM
Details	Last Recertification Date	Insert	New Registration			10/6/2023 3:44 PM
Details	Grant Number	Insert	New Registration			10/6/2023 3:44 PM
Details	340B ID	Insert	New Registration			10/6/2023 3:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/6/2023 3:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/6/2023 3:44 PM
Details	Medicare Provider Number	Insert	New Registration		521340	10/6/2023 3:44 PM
Details	Entity Name	Insert	New Registration		MCHS-RED CEDAR	10/6/2023 3:44 PM
Details	NOFO Number	Insert	New Registration			10/6/2023 3:44 PM
Details	Program Code	Insert	New Registration		CAH	10/6/2023 3:44 PM
Details	Entity Subname	Insert	New Registration		MCHS WI Orthopedic and Rehab Center	10/6/2023 3:44 PM
Dates	Participating Approval Date	Insert	New Registration			10/6/2023 3:44 PM
Details	State	Insert	New Registration		Pending	10/6/2023 3:44 PM
Dates	Registration Date	Insert	New Registration		10/6/2023 3:44:16 PM	10/6/2023 3:44 PM
Dates	Signed By Date	Insert	New Registration			10/6/2023 3:44 PM
Dates	Start Date	Insert	New Registration			10/6/2023 3:44 PM
Terminations	Termination Comments	Insert	New Registration			10/6/2023 3:44 PM
Terminations	Termination Date	Insert	New Registration			10/6/2023 3:44 PM
Terminations	Termination Effective Date	Insert	New Registration			10/6/2023 3:44 PM
Terminations	Termination Reason	Insert	New Registration			10/6/2023 3:44 PM