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MAYO CLINIC PHARMACY
RRC520004-58 MCHS FRANCISCAN HEALTHCARE INC
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Covered Entity Details
Entity Name
MCHS FRANCISCAN HEALTHCARE INC
Subdivision Name
MCHS—Franciscan Healthcare in Onalaska—MRI
Type
Rural Referral Center
340B ID
RRC520004-58
Entity Address
191 THEATER RD
Onalaska, WI 54650
Medicare Provider Number
520004
Outpatient Facility Provider Number
Participating Start Date
7/1/2021
Last Recertification Date
9/8/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
5/18/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Morrey, Regional Chair--Administration NWWI
(715) 464-0022
Contract Pharmacy Representative
Mayo Clinic
Mike O'Brien, Director
(715) 838-6762
Signed By Date
4/13/2021
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