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ALTSCRIPTS SPECIALTY PHARMACY
CAH521333-00 BLACK RIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BLACK RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521333-00
Entity Address
711 WEST ADAMS STREET
BLACK RIVER FALLS, WI 54615
Medicare Provider Number
521333
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
ALTSCRIPTS SPECIALTY PHARMACY
Pharmacy Address
1636 MILLER PARK WAY
WEST MILWAUKEE, WI 53214-3604
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carl Selvick, President and CEO
(715) 284-1301
Contract Pharmacy Representative
Altscripts Specialty Pharmacy
Joanna Lalich, Senior Vice President of Operations
(312) 805-6277
Signed By Date
1/16/2023
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