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MARSHFIELD CLINIC PHARMACY
DSH520037 MARSHFIELD MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHFIELD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520037
Entity Address
611 St Joseph Avenue
MARSHFIELD, WI 54449
Medicare Provider Number
520037
Participating Start Date
1/1/2024
Last Recertification Date
9/5/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
MARSHFIELD CLINIC SPECIALTY PHARMACY
1000 N OAK AVE
MARSHFIELD, WI 54449
Pharmacy Comments
Contract Details
Approval Date
7/19/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Edward H Wolf, Chief Administrator Officer
(715) 387-7030
Contract Pharmacy Representative
Marshfield Medical Center
Sarah Elizabeth Rall, Director of Pharmacy
(715) 389-3173
Signed By Date
7/19/2018
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