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PICK N SAVE PHARMACY #8127
CAH521324-00 ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
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Covered Entity Details
Entity Name
ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521324-00
Entity Address
135 SOUTH GIBSON STREET
MEDFORD, WI 54451
Medicare Provider Number
521324
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PICK N SAVE PHARMACY #8127
Pharmacy Address
256 S LAKE ST
PHILLIPS, WI 54555
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
LORI PECK, CFO
(715) 748-8159
Contract Pharmacy Representative
Edward Kitz, Group VP
(920) 996-0121
Signed By Date
7/14/2014
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