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CAH521337-06 ST. CROIX REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Frederic Clinic - RHC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521337-06
Medicare Provider Number
521337
Outpatient Facility Provider Number
528555
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/27/2014
Last Recertification Date
9/10/2019
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
St. Croix Regional Medical Center
Sally Bajak, CFO
(715) 483-0556
Primary Contact
St Croix Regional Medical Center
Barb Doty, 340B Senior Analyst
(715) 483-0238
Addresses
Street Address
205 Oak Street West
Frederic, WI 54837
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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