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WALGREEN CO.
CAH521355-00 ThedaCare Medical Center Berlin, Inc.
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Covered Entity Details
Entity Name
ThedaCare Medical Center Berlin, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521355-00
Entity Address
225 MEMORIAL DRIVE
BERLIN, WI 54923
Medicare Provider Number
521355
Participating Start Date
7/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01164
1203 W FOND DU LAC ST
RIPON, WI 54971-9289
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Bending, Vice President, Critical Access Hositals
(920) 361-5585
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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