Contract Pharmacy Details

SAINT JOSEPH'S HOSP OTPA PHARM
CAH521311-00 ASPIRUS STANLEY HOSPITAL & CLINICS, INC.

Covered Entity Details

Entity Name

ASPIRUS STANLEY HOSPITAL & CLINICS, INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH521311-00

Entity Address

1120 PINE STREET
STANLEY, WI 54768

Medicare Provider Number

521311

Participating Start Date

1/1/2011

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

SAINT JOSEPH'S HOSP OTPA PHARM

Pharmacy Address

DBA ASCENSION WISCONSIN PHARMACY #701
1901 WESTWOOD CENTER BLVD
WAUSAU, WI 54401

Pharmacy Comments

Contract Details

Approval Date

4/4/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/18/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CYNTHIA EICHMAN, PRESIDENT
(715) 644-6148

Contract Pharmacy Representative

Vanessa Freitag, Director of Pharmacy
(715) 389-5302

Signed By Date

4/4/2013

340B Drug Pricing Program Database