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WISCONSIN CVS PHARMACY, L.L.C.
CAH521358-00 DOOR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DOOR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521358-00
Entity Address
323 SOUTH 18TH AVENUE
STURGEON BAY, WI 54235
Medicare Provider Number
521358
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WISCONSIN CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10419
1407 EGG HARBOR RD.
STURGEON BAY, WI 54235
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian C. Stephens, CEO
(920) 746-3737
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/8/2020
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