340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CAH521327-02 WAUPUN MEMORIAL HOSPITAL (Terminated)
Print
Main Details
Name
WAUPUN MEMORIAL HOSPITAL
Subdivision Name
Waupun Dialysis
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521327-02
Medicare Provider Number
521327
Outpatient Facility Provider Number
522301
Additional Details
Current Program Status
Terminated
Registration Date
4/27/2012
Participating Start Date
7/1/2012
Participating Approval Date
5/21/2012
Last Recertification Date
8/30/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
SSM Health
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Primary Contact
SSM Health
Michelle Nicole Schmitt, Director of Business Operations
(608) 294-6203
Addresses
Street Address
10 Beaver Dam Street
Waupun, WI 53963
Billing Address
Waupun Memorial Hospital
620 West Brown Street
Waupun, WI 53963
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session