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THRIFTY WHITE PHARMACY
CAH521341-00 THE RICHLAND HOSPITAL INC
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Covered Entity Details
Entity Name
THE RICHLAND HOSPITAL INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521341-00
Entity Address
333 EAST SECOND STREET
RICHLAND CENTER, WI 53581
Medicare Provider Number
521341
Participating Start Date
7/1/2020
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY
Pharmacy Address
190 RICHLAND SQ
RICHLAND CENTER, WI 53581
Pharmacy Comments
Contract Details
Approval Date
10/5/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/20/2021
Ownership change
Contacts
Covered Entity Signing Official
Jeffery Charles Longbrake, CFO
(608) 647-6321 Ext: 2205
Contract Pharmacy Representative
Thrifty White Pharmacy
Michelle Farrell, Owner
(608) 375-4466
Signed By Date
10/5/2020
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