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MORTON LTC
RRC520045-00 THEDACARE REGIONAL MEDICAL CENTER -
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Covered Entity Details
Entity Name
THEDACARE REGIONAL MEDICAL CENTER -
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520045-00
Entity Address
130 SECOND ST
NEENAH, WI 54956
Medicare Provider Number
520045
Participating Start Date
4/1/2025
Last Recertification Date
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
3/3/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
B Lynn Detterman, SVP, South Region
(920) 454-6380
Contract Pharmacy Representative
Morton Drug Co.
Dawn Wypiszynski@mortonltc.com, Vice President, Pharmacy Services
(920) 886-1109
Signed By Date
2/28/2025
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