340B Drug Pricing Program Database
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CAH521346-00 ThedaCare Medical Center Shawano, Inc. (Active)
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Main Details
Name
ThedaCare Medical Center Shawano, Inc.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521346-00
Medicare Provider Number
521346
Additional Details
Current Program Status
Active
Registration Date
3/7/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/15/2012
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
ThedaCare
Kellie Diedrick, Vice President of New London and Waupaca Medical Centers
(920) 851-2024
Primary Contact
ThedaCare
Nichole Tina Clark, 340B Compliance Analyst
(715) 853-3976
Addresses
Street Address
100 County Road B
Shawano, WI 54166
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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