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ACCREDO HEALTH GROUP, INC.
PED523300-00 CHILDREN'S HOSPITAL OF WISCONSIN, INC.
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Covered Entity Details
Entity Name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Subdivision Name
Type
Children's Hospital
340B ID
PED523300-00
Entity Address
9000 W. WISCONSIN AVENUE
MILWAUKEE, WI 53226
Medicare Provider Number
523300
Participating Start Date
4/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Turner, COO CHW and EVP CHHS
(414) 266-2648
Contract Pharmacy Representative
Express Scripts
Christine Myers, Account Executive - 340B
(847) 309-7037
Signed By Date
10/11/2022
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