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WISCONSIN CVS PHARMACY, L.L.C.
DSH520098 UNIVERSITY OF WI HOSPITALS & CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520098
Entity Address
600 HIGHLAND AVE
MADISON, WI 53792
Medicare Provider Number
520098
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WISCONSIN CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 7147
6701 MINERAL POINT RD
MADISON, WI 53705
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2023
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