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ASPIRUS STANLEY HOSPITAL
CAH521358-00 DOOR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DOOR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521358-00
Entity Address
323 SOUTH 18TH AVENUE
STURGEON BAY, WI 54235
Medicare Provider Number
521358
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
ASPIRUS STANLEY HOSPITAL
Pharmacy Address
1120 PINE ST
STANLEY, WI 54768
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian C. Stephens, CFO
(920) 746-3737
Contract Pharmacy Representative
Justin Guthman, Director of Pharmacy
(715) 387-9915
Signed By Date
4/15/2016
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