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CRIVITZ PHARMACY
CAH521356-00 Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital
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Covered Entity Details
Entity Name
Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521356-00
Entity Address
820 Arbutus Avenue
Oconto, WI 54153
Medicare Provider Number
521356
Participating Start Date
7/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CRIVITZ PHARMACY
Pharmacy Address
710 MAIN AVE
CRIVITZ, WI 54114
Pharmacy Comments
Contract Details
Approval Date
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie Ann Bieber, VP Oconto Hospital and Clinics
(920) 835-2932
Contract Pharmacy Representative
MEG's Pharmacy, Inc.
Ezra Gruszynski, Owner
(715) 854-7425
Signed By Date
7/10/2023
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