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MAYO CLINIC PHARMACY
CAH521340-13 Mayo Clinic Health System - Red Cedar
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Covered Entity Details
Entity Name
Mayo Clinic Health System - Red Cedar
Subdivision Name
Menomonie - Neurological Surgery
Type
Critical Access Hospital
340B ID
CAH521340-13
Entity Address
2407 Stout Road
Menomonie, WI 54751
Medicare Provider Number
521340
Outpatient Facility Provider Number
Participating Start Date
7/1/2022
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
7/18/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
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
7/18/2022
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