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MORTON LTC
CAH521355-00 ThedaCare Medical Center Berlin, Inc.
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Covered Entity Details
Entity Name
ThedaCare Medical Center Berlin, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521355-00
Entity Address
225 MEMORIAL DRIVE
BERLIN, WI 54923
Medicare Provider Number
521355
Participating Start Date
7/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MORTON LTC
Pharmacy Address
DBA MORTON DRUG CO. INC.
201 E BELL ST
NEENAH, WI 54956-5096
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Bending, Vice President, Critical Access Hositals
(920) 361-5585
Contract Pharmacy Representative
Morton Drug Co.
Dawn Wypiszynski@mortonltc.com, Vice President, Pharmacy Services
(920) 886-1109
Signed By Date
7/9/2024
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