340B Drug Pricing Program Database
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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
Shipping Addresses
Contract Pharmacies
Parent/Child
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