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DSH520011 LAKEVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
LAKEVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520011
Medicare Provider Number
520011
Additional Details
Current Program Status
Terminated
Registration Date
5/22/2019
Participating Start Date
3/15/2022
Participating Approval Date
5/31/2019
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Marshfield Medical Center-Rice Lake
Bradley Groseth, Chief Administrative Officer
(715) 236-6131
Primary Contact
Marshfield Medical Center
Kirstia Neuendorf, 340B Program Manager
(715) 858-4308
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 7/1/2015; Terminated 7/1/2018; Reinstated 7/1/2019.
05/31/2019
April 2025
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