340B Drug Pricing Program Database
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CAH521326-00 ThedaCare Medical Center - New London, Inc. (Active)
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Main Details
Name
ThedaCare Medical Center - New London, Inc.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521326-00
Medicare Provider Number
521326
Additional Details
Current Program Status
Active
Registration Date
5/15/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/19/2012
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Thedacare
Jenny Derks, Vice President, Critical Access Hospital (TCNL & TCW)
(920) 531-2226
Primary Contact
Thedacare
Spas M Prostek, 340B Compliance Analyst
(414) 758-1044
Addresses
Street Address
1405 Mill Street
New London, WI 54961
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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