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UW HEALTH
DSH520089 Meriter Health Services
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Covered Entity Details
Entity Name
Meriter Health Services
Subdivision Name
UnityPoint Health-Meriter
Type
Disproportionate Share Hospital
340B ID
DSH520089
Entity Address
202 S Park St
Madison, WI 53715
Medicare Provider Number
520089
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
UW HEALTH
Pharmacy Address
OUTPATIENT PHARMACY
600 HIGHLAND AVE RM E5-236
MADISON, WI 53792
Pharmacy Comments
Contract Details
Approval Date
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beth Erdman, CFO
(608) 417-5800
Contract Pharmacy Representative
UW HEALTH
Joseph Cesarz, Director - Ambulatory Pharmacy Services
(608) 203-4897
Signed By Date
10/11/2017
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