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MARSHFIELD CLINIC PHARMACY
CAH521328-01 MARSHFIELD MEDICAL CENTER LADYSMITH
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Covered Entity Details
Entity Name
MARSHFIELD MEDICAL CENTER LADYSMITH
Subdivision Name
MMC-Ladysmith - Cornell Clinic
Type
Critical Access Hospital
340B ID
CAH521328-01
Entity Address
600 Woodside Drive
Cornell, WI 54732
Medicare Provider Number
521328
Outpatient Facility Provider Number
Participating Start Date
4/1/2022
Last Recertification Date
8/20/2024
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
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Euclide, Chief Administrative Officer
(715) 532-6651 Ext: 41107
Contract Pharmacy Representative
MMC
Holly Fayas, Manager-Pharmacy Services
(715) 387-9100
Signed By Date
4/13/2022
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