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CAH521320-00 TOMAH MEMORIAL HOSPITAL (Active)
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Main Details
Name
TOMAH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521320-00
Medicare Provider Number
521320
Additional Details
Current Program Status
Active
Registration Date
4/7/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/23/2020
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Tomah Memorial Hospital
Joseph Zeps, CFO
(608) 372-2181
Primary Contact
Tomah Health
Todd William Chapman, Director of Pharmacy
(608) 377-8409
Addresses
Street Address
501 Gopher Drive
TOMAH, WI 54660-4513
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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