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RASMUSSEN VILLAGE PHARMACY INC
CAH521347-00 BALDWIN AREA MEDICAL CENTER INC., d/b/a Western Wisconsin Health
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Covered Entity Details
Entity Name
BALDWIN AREA MEDICAL CENTER INC., d/b/a Western Wisconsin Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521347-00
Entity Address
1100 Bergslien St
BALDWIN, WI 54002
Medicare Provider Number
521347
Participating Start Date
1/1/2016
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
RASMUSSEN VILLAGE PHARMACY INC
Pharmacy Address
DBA VILLAGE PHARMACY BALDWIN
840 MAIN ST
BALDWIN, WI 54002
Pharmacy Comments
Contract Details
Approval Date
4/6/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Lovdahl, CFO
(715) 684-8612
Contract Pharmacy Representative
David Willink, Owner
(715) 684-2674
Signed By Date
4/6/2016
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