340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WISCONSIN CVS PHARMACY, L.L.C.
CAH521317-00 Ascension Calumet Hospital, Inc.
Print
Covered Entity Details
Entity Name
Ascension Calumet Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521317-00
Entity Address
614 MEMORIAL DRIVE
CHILTON, WI 53014
Medicare Provider Number
521317
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WISCONSIN CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05186
1485 ONEIDA ST.
APPLETON, WI 54915
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session