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CHET JOHNSON DRUG INC
CAH521308-01 AMERY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AMERY REGIONAL MEDICAL CENTER
Subdivision Name
CLEAR LAKE MEDICAL CLINIC
Type
Critical Access Hospital
340B ID
CAH521308-01
Entity Address
357 3RD AVENUE
CLEAR LAKE, WI 54005
Medicare Provider Number
521308
Outpatient Facility Provider Number
Participating Start Date
9/20/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CHET JOHNSON DRUG INC
Pharmacy Address
CHET JOHNSON & SONS
204 KELLER AVE N
AMERY, WI 54001-1036
Pharmacy Comments
Contract Details
Approval Date
7/17/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SCOTT EDIN, CFO
(715) 268-0301
Contract Pharmacy Representative
Matthew Johnson, President
(715) 268-8121
Signed By Date
7/17/2013
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