340B Drug Pricing Program Database
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The Q2 2025 registration window for covered entities is open from 4/1/2025 - 4/15/2025.
CAH521337-01 ST. CROIX REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
FREDERIC CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521337-01
Medicare Provider Number
521337
Outpatient Facility Provider Number
528555
Additional Details
Current Program Status
Active
Registration Date
10/6/2010
Participating Start Date
1/1/2011
Participating Approval Date
10/7/2010
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
St. Croix Regional Medical Center
Michael Jon Youso, CEO
(715) 483-0535
Primary Contact
St. Croix Regional Medical Center
Jami Wallace, 340B Program Coordinator
(715) 483-0542
Addresses
Street Address
205 Oak Street West
FREDERIC, WI 54837
Billing Address
ST. CROIX REGIONAL MEDICAL CENTER
235 State Street
ST. CROIX FALLS, WI 54024
Comments
Medicaid Billing
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Contract Pharmacies
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