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MAYO CLINIC PHARMACY
CAH521340-04 Mayo Clinic Health System - Red Cedar
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Covered Entity Details
Entity Name
Mayo Clinic Health System - Red Cedar
Subdivision Name
MCHS-Red Cedar in Glenwood City - Radiology
Type
Critical Access Hospital
340B ID
CAH521340-04
Entity Address
219 E Oak St
Glenwood City, WI 54013-8516
Medicare Provider Number
521340
Outpatient Facility Provider Number
Participating Start Date
10/1/2020
Last Recertification Date
9/7/2021
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
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michele Eberle, Vice Chair-Administration NWWI
(715) 568-6113
Contract Pharmacy Representative
Mayo Clinic
Mike O'Brien, Director
(715) 838-6762
Signed By Date
10/8/2021
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