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ALGOMA HOMETOWN PHARMACY LLC
CAH521358-00 DOOR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DOOR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521358-00
Entity Address
323 SOUTH 18TH AVENUE
STURGEON BAY, WI 54235
Medicare Provider Number
521358
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
ALGOMA HOMETOWN PHARMACY LLC
Pharmacy Address
DBA ALGOMA HOMETOWN PHARMACY
801 JEFFERSON ST
ALGOMA, WI 54201
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian C. Stephens, CEO
(920) 746-3737
Contract Pharmacy Representative
Sturgeon Bay Hometown Pharmacy
Daniel Strause, Manager
(608) 516-2076
Signed By Date
7/12/2018
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