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RRC520004-16 Mayo Clinic Health System-Franciscan Healthcare La Crosse (Terminated)
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Main Details
Name
Mayo Clinic Health System-Franciscan Healthcare La Crosse
Subdivision Name
MAYO CLINIC HEALTH SYSTEM - FRANCIS - LA CRESCENT FAMILY MEDICINE (RRC)
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520004-16
Medicare Provider Number
520004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/10/2018
Last Recertification Date
8/29/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Mayo Clinic Health System
Julie Schaus Hansen, CFO-Wisconsin
(715) 838-5270
Primary Contact
Mayo Clinic
Jenni Hovell, 340B Operations Manager
(507) 284-5061
Addresses
Street Address
524 N ELM ST
LA CRESCENT, MN 55947-1027
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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