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ASCENSION WISCONSIN PHARMACY, INC
CAH521311-00 ASPIRUS STANLEY HOSPITAL & CLINICS, INC.
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Covered Entity Details
Entity Name
ASPIRUS STANLEY HOSPITAL & CLINICS, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521311-00
Entity Address
1120 PINE STREET
STANLEY, WI 54768
Medicare Provider Number
521311
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
ASCENSION WISCONSIN PHARMACY, INC
Pharmacy Address
DBA ASCENSION RX 701
1901 WESTWOOD CENTER BLVD
WAUSAU, WI 54401
Pharmacy Comments
Contract Details
Approval Date
1/19/2021
Contract Begin Date
1/19/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/26/2021
Ownership change
Contacts
Covered Entity Signing Official
Jonathon Matuszewski, Hospital President
(414) 647-5106
Contract Pharmacy Representative
Ascension
Michael Torhorst, Regional Director Retail Pharmacy
(262) 687-2161
Signed By Date
1/19/2021
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