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UNITY PHARMACY, LLC.
CAH521337-03 ST. CROIX REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
ST. CROIX FALLS CLINIC
Type
Critical Access Hospital
340B ID
CAH521337-03
Entity Address
216 South Adams Street
ST. CROIX FALLS, WI 54024
Medicare Provider Number
521337
Outpatient Facility Provider Number
528604
Participating Start Date
1/1/2011
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
UNITY PHARMACY, LLC.
Pharmacy Address
1504 190TH AVE
SUITE 100
BALSAM LAKE, WI 54810-7102
Pharmacy Comments
06/18/2012 update address (added Suite)
Contract Details
Approval Date
1/5/2012
Contract Begin Date
1/29/2012
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
12/30/2011
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