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MAYO CLINIC PHARMACY
CAH521305-00 MCHS-FRANCISCAN SPARTA
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Covered Entity Details
Entity Name
MCHS-FRANCISCAN SPARTA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521305-00
Entity Address
310 W MAIN
SPARTA, WI 54656
Medicare Provider Number
521305
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tanner Holst, Regional Chair-Administration SWWI
(608) 392-9705
Contract Pharmacy Representative
Mayo Clinic
Jordan Daniel Haag, Associate Chief Pharmacy Officer
(507) 284-5722
Signed By Date
4/15/2025
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