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DSH520087D Gundersen Lutheran Medical Center, Inc. (Terminated)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Hemodialysis - Black River Falls
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087D
Medicare Provider Number
520087
Outpatient Facility Provider Number
523530
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/21/2018
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Gundersen Health System, La Crosse, WI
Kay P Marsyla, Director, Reimbursement
(608) 775-0171
Primary Contact
Gundersen Health System
Loren Carrell, Director
(608) 775-6369
Addresses
Street Address
711 Adams Street
Black River Falls, WI 54615
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participation started 7/1/2012; Terminated on 7/1/2017; Reinstated on 4/1/2018.
02/20/2018
April 2025
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