340B Drug Pricing Program Database

Pharmacy Name

THEDACARE PHARMACY - GREEN LAKE

Pharmacy Address

THEDACARE MEDICAL CENTER - BERLIN, INC.
762 COMMERCIAL AVE
GREEN LAKE, WI 54941

Pharmacy Comments

Approval Date

7/11/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016
Pharmacy closed

Covered Entity Signing Official

Thomas P. Krystowiak, Chief Financial Officer
(920) 361-1313

Contract Pharmacy Representative

Kasi Ludwig, Manager of pharmacy operations
(920) 361-6560

Signed By Date

7/11/2013