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SAINT JOSEPH'S HOSP OTPA PHARM
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520019-00
Entity Address
2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501
Medicare Provider Number
520019
Participating Start Date
10/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
SAINT JOSEPH'S HOSP OTPA PHARM
Pharmacy Address
DBA ASCENSION WISCONSIN PHARMACY #701
1901 WESTWOOD CENTER BLVD
WAUSAU, WI 54401
Pharmacy Comments
Contract Details
Approval Date
4/16/2012
Contract Begin Date
4/16/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bill Erickson, Vice President-Operations
(715) 361-2012
Contract Pharmacy Representative
Angela Schlagel, Pharmacy Manager
(715) 387-7687
Signed By Date
3/29/2012
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