340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CH050900 LA CLINICA DE LOS CAMPESINOS, INC. (Active)
Print
Main Details
Name
LA CLINICA DE LOS CAMPESINOS, INC.
Subdivision Name
Noble Community Clinics - Wautoma
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003648
340B ID
CH050900
Grant Number
H80CS00713
Additional Details
Current Program Status
Active
Registration Date
4/1/1996
Participating Start Date
4/1/1996
Participating Approval Date
11/3/2004
Last Recertification Date
2/13/2025
Contacts
Authorizing Official
La Clinica de los Campesinos
Laura Waldvogel, CEO
(920) 787-9406
Primary Contact
La Clinica De Los Campesinos, Inc.
Kellen J Dorff, Director of Pharmacy
(920) 647-8984
Addresses
Street Address
400 S. Townline Rd
WAUTOMA, WI 54982-1440
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
11/3/04 THIS RECORD NOW COMBINES THE INFO FROM MH050900
01/14/2010
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session