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CAH521338-00 PRAIRIE RIDGE HEALTH, INC. (Active)
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Main Details
Name
PRAIRIE RIDGE HEALTH, INC.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521338-00
Medicare Provider Number
521338
Additional Details
Current Program Status
Active
Registration Date
2/21/2011
Participating Start Date
1/1/2014
Participating Approval Date
3/8/2011
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Prairie Ridge Health, Inc.
Melissa S. Mangan, Vice President of Finance/Chief Financial Officer
(920) 623-1369
Primary Contact
Prairie Ridge Health, Inc.
Nathan Reabe, Pharmacy Manager
(920) 623-1381
Addresses
Street Address
1515 PARK AVENUE
COLUMBUS, WI 53925-1618
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/15/13 participating 4/1/11 thru 9/30/13, not participating 10/1/13 thru 12/31/13 due to failure to recertify, re-instated based on on-line registration submitted in Oct. 2013
11/15/2013
April 2025
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