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CUBA CITY HOMETOWN PHARMACY LLC
CAH521354-00 SOUTHWEST HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHWEST HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521354-00
Entity Address
1400 EAST SIDE ROAD
PLATTEVILLE, WI 53818
Medicare Provider Number
521354
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CUBA CITY HOMETOWN PHARMACY LLC
Pharmacy Address
DBA CUBA CITY HOMETOWN PHARMACY
122 N MAIN ST
CUBA CITY, WI 53807-1538
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jesse William Sookochoff, Chief Financial Officer
(608) 342-4705
Contract Pharmacy Representative
Hometown Pharmacy
Jon Wilson, Owner
(608) 744-2440
Signed By Date
7/3/2024
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