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UNITY PHARMACY, LLC.
CAH521337-05 ST. CROIX REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Unity Clinic
Type
Critical Access Hospital
340B ID
CAH521337-05
Entity Address
1504 190th Avenue
Balsam Lake, WI 54810
Medicare Provider Number
521337
Outpatient Facility Provider Number
528605
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
UNITY PHARMACY, LLC.
Pharmacy Address
1504 190TH AVE
SUITE 100
BALSAM LAKE, WI 54810-7102
Pharmacy Comments
06/18/2012 update address (added Suite)
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Tremble, CFO
(715) 483-0317
Contract Pharmacy Representative
St. Croix Health
Anita Lundquist, Director of Pharmacy
(715) 483-0236
Signed By Date
4/15/2013
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