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SCH520011-00 LAKEVIEW MEDICAL CENTER OF RICE LAKE (ToBeTerminated)
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Main Details
Name
LAKEVIEW MEDICAL CENTER OF RICE LAKE
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH520011-00
Medicare Provider Number
520011
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/15/2023
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Marshfield Clinic Health System
Jeffrey Poppen, CFO
(715) 387-5119
Primary Contact
Marshfield Clinic Health System
Christina Kellar, Director - 340B
(262) 328-7086
Addresses
Street Address
1700 WEST STOUT STREET
RICE LAKE, WI 54868
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 8/18/2021; Terminated 3/15/2022; Reinstated 10/1/2023.
09/14/2023
Participating from effective date: 07/02/2018 until terminated effective date: 07/01/2019; reinstatement effective date: 10/01/2021
08/16/2021
Participated starting 10/1/2013, terminated 7/1/2015. Reinstated 7/2/2018.
07/02/2018
June 2025
June 2025
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