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MAYO CLINIC HEALTH SYSTEM-OAKRIDGE HOSP
RRC520070-00 MCHS EAU CLAIRE HOSPITAL
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Covered Entity Details
Entity Name
MCHS EAU CLAIRE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520070-00
Entity Address
1221 WHIPPLE STREET
EAU CLAIRE, WI 54703
Medicare Provider Number
520070
Participating Start Date
7/1/2018
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MAYO CLINIC HEALTH SYSTEM-OAKRIDGE HOSP
Pharmacy Address
13025 8TH. STREET
P.O. BOX 70
OSSEO, WI 54758
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2025
Ownership change
Contacts
Covered Entity Signing Official
Michele Eberle, Vice Chair-Administration NWWI
(715) 568-6113
Contract Pharmacy Representative
Mayo Clinic
Jordan Daniel Haag, Associate Chief Pharmacy Officer
(507) 284-5722
Signed By Date
7/15/2024
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