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MEDICAL CENTER PHARMACY
CH053060 Sixteenth Street Community Health Centers, Inc.
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Covered Entity Details
Entity Name
Sixteenth Street Community Health Centers, Inc.
Subdivision Name
Sixteenth Street Community Health Centers-Chavez
Type
HRSA-Funded Health Center
340B ID
CH053060
Entity Address
1032 S Cesar E Chavez Dr
MILWAUKEE, WI 53204
Grant Number
H80CS00593
Participating Start Date
10/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
1111 DELAFIELD ST STE 109
WAUKESHA, WI 53188-3402
Pharmacy Comments
Contract Details
Approval Date
1/2/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Liz Claudio, Vice President, Operations
(414) 897-5165
Contract Pharmacy Representative
Medical Center Pharmacy
Scott Hoff, Owner
(262) 544-5303
Signed By Date
1/2/2020
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