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HARTIG DRUG CO., INC.
CAH521322-00 GRANT REGIONAL HEALTH CENTER INC.
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Covered Entity Details
Entity Name
GRANT REGIONAL HEALTH CENTER INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521322-00
Entity Address
507 SOUTH MONROE STREET
LANCASTER, WI 53813
Medicare Provider Number
521322
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
HARTIG DRUG CO., INC.
Pharmacy Address
139 W MAPLE ST
LANCASTER, WI 53813-1640
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawn M Bandy, CFO
(608) 723-3202
Contract Pharmacy Representative
Hartig Drug Company
Charles S Hartig, VP & GC
(563) 588-8700 Ext: 10012
Signed By Date
4/12/2019
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