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SSM HEALTH PHARMACY
CAH521321-00 Ripon Medical Center, Inc.
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Covered Entity Details
Entity Name
Ripon Medical Center, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521321-00
Entity Address
845 Parkside Street
Ripon, WI 54971
Medicare Provider Number
521321
Participating Start Date
1/1/2012
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
SSM HEALTH PHARMACY
Pharmacy Address
310 INTEGRITY DR
MADISON, WI 53717-1416
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Contract Pharmacy Representative
Lumicera
Eric Huckins, Manager
(608) 716-2667
Signed By Date
7/12/2024
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