Contract Pharmacy Details

JOHNSON DRUG AT ARMC
CAH521308-03 AMERY REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

AMERY REGIONAL MEDICAL CENTER

Subdivision Name

Luck Medical Clinic

Type

Critical Access Hospital

340B ID

CAH521308-03

Entity Address

2547 State Road 35
Suite 1
Luck, WI 54853

Medicare Provider Number

521308

Outpatient Facility Provider Number

528516

Participating Start Date

7/1/2013

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

JOHNSON DRUG AT ARMC

Pharmacy Address

265 GRIFFIN ST E
AMERY, WI 54001-1439

Pharmacy Comments

Contract Details

Approval Date

7/17/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/16/2021
Ownership change

Contacts

Covered Entity Signing Official

SCOTT EDIN, CFO
(715) 268-0301

Contract Pharmacy Representative

Matthew Johnson, President
(715) 268-8121

Signed By Date

7/17/2013