340B Drug Pricing Program Database

Name

Memorial Medical Center, Inc.

Subdivision Name

PSYCHIATRIC/PSYCHOLOGICAL SERVICES

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521359-01

Medicare Provider Number

521359

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

1/2/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/13/2015

Last Recertification Date

8/15/2018

Termination Date
Termination Reason

10/1/2019
Never implemented the 340B Program

Authorizing Official

Memorial Medical Center, Inc.
Kent Dumonseau, Chief Financial Officer
(715) 685-5515

Primary Contact

Memorial Medical Center
William Mattila, Director of Pharmacy
(715) 685-5490

Street Address

1635 Maple Lane
ASHLAND, WI 54806

Billing Address

Memorial Medical Center
1615 Maple Lane
Ashland, WI 54806