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MARSHFIELD CLINIC PHARMACY
SCH520011-00 LAKEVIEW MEDICAL CENTER OF RICE LAKE
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Covered Entity Details
Entity Name
LAKEVIEW MEDICAL CENTER OF RICE LAKE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520011-00
Entity Address
1700 WEST STOUT STREET
RICE LAKE, WI 54868
Medicare Provider Number
520011
Participating Start Date
10/1/2023
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
MARSHFIELD CLINIC SPECIALTY PHARMACY
1000 N OAK AVE
MARSHFIELD, WI 54449
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bradley Groseth, Chief Administrative Officer
(715) 236-6131
Contract Pharmacy Representative
MMC
Holly Fayas, Manager-Pharmacy Services
(715) 387-9100
Signed By Date
10/4/2023
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