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WALGREEN CO.
SCH520037-00 MARSHFIELD MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHFIELD MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520037-00
Entity Address
611 ST JOSEPH AVENUE
MARSHFIELD, WI 54449
Medicare Provider Number
520037
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09009
3200 8TH STREET S
WISCONSIN RAPIDS, WI 54494-6563
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
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
PETER STAMAS, VICE PRESIDENT MEDICAL AFFAIRS
(715) 387-7030
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2014
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