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CAH521305-01 Mayo Clinic Health System-Franciscan Healthcare Sparta (Terminated)
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Main Details
Name
Mayo Clinic Health System-Franciscan Healthcare Sparta
Subdivision Name
Sparta Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521305-01
Medicare Provider Number
521305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/1/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/14/2011
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Mayo Clinic Health System Northwest Wisconsin
Michael Morrey, Regional Chair--Administration NWWI
(715) 464-0022
Primary Contact
Mayo Clinic
Darrin Christopherson, Senior Business Analyst-340B Midwest Programs
(507) 284-5035
Addresses
Street Address
310 West Main Street
Sparta, WI 54656
Billing Address
Mayo Clinic Health System - Franciscan Medical Center Inc.
700 West Avenue
LaCrosse, WI 54601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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