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MARSHFIELD CLINIC PHARMACY
SCH520011-00 LAKEVIEW MEDICAL CENTER OF RICE LAKE
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Covered Entity Details
Entity Name
LAKEVIEW MEDICAL CENTER OF RICE LAKE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520011-00
Entity Address
1700 WEST STOUT STREET
RICE LAKE, WI 54868
Medicare Provider Number
520011
Participating Start Date
10/1/2023
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
1200 PORT ARTHUR RD STE 100
LADYSMITH, WI 54848
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/22/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jolene Anderson, Regional Operations Administrator
(715) 236-8413
Contract Pharmacy Representative
Marshfield Medical Center
Sarah Elizabeth Rall, Director of Pharmacy
(715) 389-3173
Signed By Date
10/8/2018
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