340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SIREN PHARMACY
CAH521337-00 ST. CROIX REGIONAL MEDICAL CENTER
Print
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
SIREN PHARMACY
Pharmacy Address
24106 STATE RD 35
PO BOX 503
SIREN, WI 54872
Pharmacy Comments
Contract Details
Approval Date
10/3/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
John Tremble, CFO
(715) 483-0317
Contract Pharmacy Representative
SIREN PHARMACY
John Peterson, Owner
(715) 349-2221
Signed By Date
10/3/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session