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PARK PHARMACY
CAH521325-00 FLAMBEAU HOSPITAL INC.
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Covered Entity Details
Entity Name
FLAMBEAU HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521325-00
Entity Address
98 SHERRY AVENUE
PARK FALLS, WI 54552-0310
Medicare Provider Number
521325
Participating Start Date
7/1/2021
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PARK PHARMACY
Pharmacy Address
138 2ND AVE N
PARK FALLS, WI 54552-1214
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Euclide, Chief Administrative Officer
(715) 532-6651 Ext: 41107
Contract Pharmacy Representative
Park Pharmacy Inc
Mark Pechacek, President
(715) 762-3283
Signed By Date
1/14/2022
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