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CAH521337-05 ST. CROIX REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Unity Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521337-05
Medicare Provider Number
521337
Outpatient Facility Provider Number
528605
Additional Details
Current Program Status
Active
Registration Date
1/7/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/14/2013
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
St. Croix Regional Medical Center
Michael Jon Youso, CEO
(715) 483-0535
Primary Contact
St. Croix Regional Medical Center
Jami Wallace, 340B Program Coordinator
(715) 483-0542
Addresses
Street Address
1504 190th Avenue
Balsam Lake, WI 54810
Billing Address
St. Croix Regional Medical Center
235 State Street
St. Croix Falls, WI 54024
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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