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ACCREDO HEALTH GROUP, INC.
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
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
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
Carl Selvick, President and CEO
(715) 284-1301
Contract Pharmacy Representative
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
10/4/2023
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