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AURORA PHARMACY
DSH520035 AURORA HEALTH CARE CENTRAL INC.DBA AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AURORA HEALTH CARE CENTRAL INC.DBA AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520035
Entity Address
3400 UNION AVE
SHEBOYGAN, WI 53081
Medicare Provider Number
520035
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AURORA PHARMACY
Pharmacy Address
AURORA PHARMACY INC.
620 S WISCONSIN DRIVE
HOWARDS GROVE, WI 53083
Pharmacy Comments
Contract Details
Approval Date
9/22/2011
Contract Begin Date
9/22/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/20/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David G. Yeager, Secretary/Treasurer
(414) 649-6797
Contract Pharmacy Representative
Thomas W. Woller, SVP, Pharmacy Services
(414) 382-1829
Signed By Date
9/19/2011
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