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WALGREEN CO.
CAH521321-00 Ripon Medical Center, Inc.
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Covered Entity Details
Entity Name
Ripon Medical Center, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521321-00
Entity Address
845 Parkside Street
Ripon, WI 54971
Medicare Provider Number
521321
Participating Start Date
1/1/2012
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11649
999 E. MAIN ST.
WAUPUN, WI 53963-2210
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2022
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