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SHOPKO PHARMACY #2120
CAH521354-00 SOUTHWEST HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTHWEST HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521354-00
Entity Address
1400 EAST SIDE ROAD
PLATTEVILLE, WI 53818
Medicare Provider Number
521354
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2120
Pharmacy Address
405 WEST EIGHT ST.
MONROE, WI 53566
Pharmacy Comments
Contract Details
Approval Date
1/27/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Dan Rohrbach, CEO
(608) 342-4701
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
1/27/2017
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