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CAH521331-00 BURNETT MEDICAL CENTER INC (Active)
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Main Details
Name
BURNETT MEDICAL CENTER INC
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH521331-00
Medicare Provider Number
521331
Additional Details
Current Program Status
Active
Registration Date
10/6/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/21/2014
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Burnett Medical Center
Mike Mullins, CFO
(715) 463-7281
Primary Contact
Burnett Medical Center Inc
Eric John Stomberg, PharmD
(715) 463-7262
Addresses
Street Address
257 W SAINT GEORGE STREET
GRANTSBURG, WI 54840
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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