Contract Pharmacy Details

AURORA PHARMACY
CH050900 LA CLINICA DE LOS CAMPESINOS, INC.

Covered Entity Details

Entity Name

LA CLINICA DE LOS CAMPESINOS, INC.

Subdivision Name

Noble Community Clinics - Wautoma

Type

HRSA-Funded Health Center

340B ID

CH050900

Entity Address

400 S. Townline Rd
WAUTOMA, WI 54982-1440

Grant Number

H80CS00713

Participating Start Date

4/1/1996

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

AURORA PHARMACY

Pharmacy Address

900 E DIVISION ST
WAUTOMA, WI 54982-6944

Pharmacy Comments

Contract Details

Approval Date

4/15/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

Laura Waldvogel, CEO
(920) 787-9406

Contract Pharmacy Representative

John Gates, VP pharmacy operations
(262) 787-2150

Signed By Date

4/15/2016