Contract Pharmacy Details

IC PHARMACY LLC
DSH520037 MARSHFIELD MEDICAL CENTER

Covered Entity Details

Entity Name

MARSHFIELD MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520037

Entity Address

611 St Joseph Avenue
MARSHFIELD, WI 54449

Medicare Provider Number

520037

Participating Start Date

1/1/2024

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

IC PHARMACY LLC

Pharmacy Address

AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232

Pharmacy Comments

Contract Details

Approval Date

1/15/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robert Chaloner, President-Marshfield Medical Center-Marshfield/Neillsville
(715) 387-7855

Contract Pharmacy Representative

PillPack, LLC dba PillPack by Amazon Pharmacy
Bridget O'Connell, Managing Officer
(602) 793-8552

Signed By Date

1/15/2025

340B Drug Pricing Program Database