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AURORA PRESCRIPTION DISPENSING CENTER #1
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 PRESCRIPTION DISPENSING CENTER #1
Pharmacy Address
AURORA PHARMACY, INC
200 E RYAN RD STE 101
OAK CREEK, WI 53154-4563
Pharmacy Comments
06/22/2012 changed zip (was 54221)
Contract Details
Approval Date
10/12/2011
Contract Begin Date
10/12/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/5/2017
Pharmacy closed
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
9/28/2011
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