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ASCENSION WISCONSIN PHARMACY, INC
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520019-00
Entity Address
2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501
Medicare Provider Number
520019
Participating Start Date
10/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
ASCENSION WISCONSIN PHARMACY, INC
Pharmacy Address
DBA ASCENSION RX 704
2251 N SHORE DR
RHINELANDER, WI 54501-6710
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/26/2021
Ownership change
Contacts
Covered Entity Signing Official
Laurie Oungst, Chief Administrative Officer
(715) 356-8560
Contract Pharmacy Representative
Ascension
Michael Torhorst, Regional Director Retail Pharmacy
(262) 687-2161
Signed By Date
4/10/2020
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