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ASPIRUS PHARMACY - MEDFORD
CAH521350-00 LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
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Covered Entity Details
Entity Name
LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521350-00
Entity Address
112 E. 5TH AVENUE
ANTIGO, WI 54409
Medicare Provider Number
521350
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ASPIRUS PHARMACY - MEDFORD
Pharmacy Address
ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
139 S GIBSON ST
MEDFORD, WI 54451-1622
Pharmacy Comments
Contract Details
Approval Date
10/16/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAT TINCHER, Vice President-Finance, Regional Markets
(715) 847-2425
Contract Pharmacy Representative
Rick Boehm, Director of Pharmacy Services
(715) 748-8121
Signed By Date
10/16/2016
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