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BOSCOBEL PHARMACY INC.
CAH521344-00 Memorial Hospital of Boscobel
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Covered Entity Details
Entity Name
Memorial Hospital of Boscobel
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521344-00
Entity Address
205 Parker St
Boscobel, WI 53805
Medicare Provider Number
521344
Participating Start Date
4/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
BOSCOBEL PHARMACY INC.
Pharmacy Address
1028 WISCONSIN AVE
BOSCOBEL, WI 53805-1532
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa Uselman, CFO
(608) 375-4112
Contract Pharmacy Representative
Thrifty White Pharmacy
Michelle Farrell, Owner
(608) 375-4466
Signed By Date
4/15/2016
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