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RRC520045-00 THEDACARE REGIONAL MEDICAL CENTER - (Active)
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Main Details
Name
THEDACARE REGIONAL MEDICAL CENTER -
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520045-00
Medicare Provider Number
520045
Additional Details
Current Program Status
Active
Registration Date
2/28/2025
Participating Start Date
4/1/2025
Participating Approval Date
3/3/2025
Last Recertification Date
Contacts
Authorizing Official
ThedaCare
B Lynn Detterman, SVP, South Region
(920) 454-6380
Primary Contact
ThedaCare
Stephanie Rhein, Director, Retail Pharmacy & 340B
(920) 454-1175
Addresses
Street Address
130 SECOND ST
NEENAH, WI 54956
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 4/1/2023, Termination 10/1/2024, Reinstatement 4/1/2025
03/03/2025
April 2025
April 2025
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