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CAH521334-00 ThedaCare Medical Center - Waupaca (Active)
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Main Details
Name
ThedaCare Medical Center - Waupaca
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521334-00
Medicare Provider Number
521334
Additional Details
Current Program Status
Active
Registration Date
4/8/2013
Participating Start Date
7/1/2013
Participating Approval Date
4/26/2013
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
Nicole A Roberts, 340B Compliance Analyst
(920) 740-8473
Addresses
Street Address
800 Riverside Drive
Waupaca, WI 54981
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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