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MAYO CLINIC PHARMACY
RRC520004-11 MCHS FRANCISCAN HEALTHCARE INC
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Covered Entity Details
Entity Name
MCHS FRANCISCAN HEALTHCARE INC
Subdivision Name
Mayo Clinic Health System—Franciscan Healthcare in Holmen—Pediatrics
Type
Rural Referral Center
340B ID
RRC520004-11
Entity Address
1303 SOUTH MAIN STREET
HOLMEN, WI 54636-8927
Medicare Provider Number
520004
Outpatient Facility Provider Number
Participating Start Date
7/1/2021
Last Recertification Date
9/8/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
5/17/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
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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