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EDGERTON CHEMISTS, INC.
CAH521319-00 EDGERTON HOSPITAL & HEALTH SERVICES
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Covered Entity Details
Entity Name
EDGERTON HOSPITAL & HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521319-00
Entity Address
11101 N SHERMAN ROAD
EDGERTON, WI 53534
Medicare Provider Number
521319
Participating Start Date
10/1/2015
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
EDGERTON CHEMISTS, INC.
Pharmacy Address
DBA EDGERTON PHARMACY
1011 N MAIN ST
EDGERTON, WI 53534-1325
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Roeder, Vice President/CFO
(608) 884-1656
Contract Pharmacy Representative
Edgerton Pharmacy
Joseph D Riebe, Pharmacy District Manager
(608) 931-6829
Signed By Date
4/15/2021
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