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RRC520004-11 MCHS FRANCISCAN HEALTHCARE INC (Terminated)
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Main Details
Name
MCHS FRANCISCAN HEALTHCARE INC
Subdivision Name
Mayo Clinic Health System—Franciscan Healthcare in Holmen—Pediatrics
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520004-11
Medicare Provider Number
520004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/17/2021
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
7/1/2022
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Mayo Clinic Health System Northwest Wisconsin
Michael Morrey, Regional Chair--Administration NWWI
(715) 464-0022
Primary Contact
Mayo Clinic
Alicia Buda, Operations Manager
(507) 293-3251
Addresses
Street Address
1303 SOUTH MAIN STREET
HOLMEN, WI 54636-8927
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2018; Terminated 7/1/2019; Reinstated 7/1/2021.
05/17/2021
May 2025
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