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MARSHFIELD CLINIC PHARMACY
RRC520076-00 BEAVER DAM COMMUNITY HOSPITALS
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Covered Entity Details
Entity Name
BEAVER DAM COMMUNITY HOSPITALS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520076-00
Entity Address
707 SOUTH UNIVERSITY AVENUE
BEAVER DAM, WI 53916
Medicare Provider Number
520076
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
MARSHFIELD CLINIC SPECIALTY PHARMACY
1000 N OAK AVE
MARSHFIELD, WI 54449
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janette Townsend, CFO
(775) 750-2197
Contract Pharmacy Representative
MMC
Holly Fayas, Manager-Pharmacy Services
(715) 387-9100
Signed By Date
10/15/2024
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