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M & J OF CUMBERLAND, INC.
CAH521353-00 Cumberland Memorial Hospital, Inc.
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Covered Entity Details
Entity Name
Cumberland Memorial Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521353-00
Entity Address
1705 16th Ave
Cumberland, WI 54829
Medicare Provider Number
521353
Participating Start Date
1/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
M & J OF CUMBERLAND, INC.
Pharmacy Address
THE APOTHECARY
1470 WEBB ST
CUMBERLAND, WI 54829
Pharmacy Comments
Contract Details
Approval Date
1/5/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Radzak, Director of Pharmacy
(715) 822-7112
Contract Pharmacy Representative
The Apothecary
Mary Babka-Goldsmith, Owner
(715) 822-2424
Signed By Date
1/5/2018
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