340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GUNDERSEN PHARMACY
DSH520087 Gundersen Lutheran Medical Center, Inc.
Print
Covered Entity Details
Entity Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520087
Entity Address
1900 South Ave
La Crosse, WI 54601
Medicare Provider Number
520087
Participating Start Date
7/1/2012
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
GUNDERSEN PHARMACY
Pharmacy Address
500 N HOLMEN DR
STE 506
HOLMEN, WI 54636
Pharmacy Comments
Contract Details
Approval Date
1/24/2019
Contract Begin Date
1/24/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kay P Marsyla, Director, Reimbursement
(608) 775-0171
Contract Pharmacy Representative
Gundersen Health System
Loren Carrell, Director
(608) 775-6369
Signed By Date
1/24/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session