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MARSHFIELD CLINIC PHARMACY
DSH520210 MARSHFIELD MEDICAL CENTER-EAU CLAIRE
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Covered Entity Details
Entity Name
MARSHFIELD MEDICAL CENTER-EAU CLAIRE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520210
Entity Address
2310 Craig Road
EAU CLAIRE, WI 54701
Medicare Provider Number
520210
Participating Start Date
10/1/2021
Last Recertification Date
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
MARSHFIELD CLINIC SPECIALTY PHARMACY
1000 N OAK AVE
MARSHFIELD, WI 54449
Pharmacy Comments
Contract Details
Approval Date
7/26/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bill Priest, CAO
(715) 858-4782
Contract Pharmacy Representative
MMC
Holly Fayas, Manager-Pharmacy Services
(715) 387-9100
Signed By Date
7/7/2021
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