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DENNIS L HUNT PHARMACY
CH050900 LA CLINICA DE LOS CAMPESINOS, INC.
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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
DENNIS L HUNT PHARMACY
Pharmacy Address
OMRO PHARMACY
KEN BRESSERS
328 E MAIN ST
OMRO, WI 54963-5496
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laura Waldvogel, CEO
(920) 787-9406
Contract Pharmacy Representative
Greg Isaak, CEO
(305) 854-5535
Signed By Date
7/13/2016
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