Contract Pharmacy Details

SMARTSCRIPTS
SCH520109-00 MILE BLUFF MEDICAL CENTER INC.

Covered Entity Details

Entity Name

MILE BLUFF MEDICAL CENTER INC.

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH520109-00

Entity Address

1050 DIVISION STREET
Mauston, WI 53948

Medicare Provider Number

520109

Participating Start Date

1/1/2016

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

SMARTSCRIPTS

Pharmacy Address

1010 W MADISON ST
WASHINGTON, IA 52353-1624

Pharmacy Comments

Contract Details

Approval Date

1/20/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dara Beth Bartels, Chief Executive Officer
(608) 847-2992

Contract Pharmacy Representative

SmartScripts
Todd Thompson, CEO
(319) 330-4328

Signed By Date

1/20/2023

340B Drug Pricing Program Database