340B Drug Pricing Program Database
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CAH521309-00 Moundview Memorial Hospital and Clinics, Inc. (Active)
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Main Details
Name
Moundview Memorial Hospital and Clinics, Inc.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521309-00
Medicare Provider Number
521309
Additional Details
Current Program Status
Active
Registration Date
8/9/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/20/2011
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Emplify Health
Kristy Millering, Finance Administrator
(608) 782-7300 Ext: 64024
Primary Contact
Moundview - Friendship Hospital and Clinics
Brad Shaw, Pharmacy Manager
(608) 782-7300 Ext: 78367
Addresses
Street Address
402 West Lake Street
Friendship, WI 53934
Billing Address
Moundview Memorial Hospital and Clinics, Inc.
P.O. Box 40
402 W Lake Street
Friendship, WI 53934
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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