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FREDERIC PHARMACY
CAH521337-00 ST. CROIX REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521337-00
Entity Address
235 STATE STREET
ST. CROIX FALLS, WI 54024
Medicare Provider Number
521337
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
FREDERIC PHARMACY
Pharmacy Address
201 OAK ST W
FREDERIC, WI 54837-8953
Pharmacy Comments
Contract Details
Approval Date
10/3/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Tremble, CFO
(715) 483-0317
Contract Pharmacy Representative
St. Croix Health
Anita Lundquist, Director of Pharmacy
(715) 483-0236
Signed By Date
10/3/2014
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