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SHOPKO PHARMACY #2792
CAH521313-00 ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC. - DBA ASPIRUS TOMAHAWK HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC. - DBA ASPIRUS TOMAHAWK HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521313-00
Entity Address
401 West Mohawk Drive
Tomahawk, WI 54487
Medicare Provider Number
521313
Participating Start Date
4/1/2012
Last Recertification Date
9/1/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2792
Pharmacy Address
79 HOMETOWN DR.
TOMAHAWK, WI 54487
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Monica Hilt, Regional VP And Hospital President
(920) 831-8913
Contract Pharmacy Representative
Shopko
Tad Schilke, Director of Rx Merchandising & Marketing
(920) 429-7628
Signed By Date
4/16/2014
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