Covered Entity Details

DSH520138ED AURORA HEALTH CARE METRO, INC. (Active) - information as of 4/29/2025 11:45:40 PM

Main Details

Name

AURORA HEALTH CARE METRO, INC.

Subdivision Name

Aurora St. Lukes South Shore - Pain Management - Pain Management

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH520138ED

Medicare Provider Number

520138

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/5/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/6/2024

Last Recertification Date

Contacts

Authorizing Official

Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765

Primary Contact

Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457

Addresses

Street Address

5900 South Lake Dr
Cudahy, WI 53110

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WI		1861447179
IL		1861447179

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH520138AA	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	8901 W. Lincoln Ave.	West Allis	WI	Active
DSH520138AB	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	975 Port Washington Rd.	Grafton	WI	Active
DSH520138AC	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Rehabilitation Center	W231 N1440 Corporate Ct.	Waukesha	WI	Terminated
DSH520138AD	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	36500 Aurora Dr.	Summit	WI	Active
DSH520138AE	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Urgent Care of Aurora Sinai Medical Center	946 N Van Buren St	Milwaukee	WI	Terminated
DSH520138AF	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ADT VLCC	1218 W. Kilbourn Ave. Suite 200	Milwaukee	WI	Active
DSH520138AG	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS VLCC	5900 S Lake Dr.	Cudahy	WI	Active
DSH520138AJ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Minor Outpatient Surgery	945 N 12th st	Milwaukee	WI	Active
DSH520138AK	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora Sinai Medical Center / ASMC Nuclear Stress Cardiology	960 N 12th St.	Milwaukee	WI	Terminated
DSH520138AL	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora Sinai Medical Center / ASMC Cardiac Stress	960 N 12th St.	Milwaukee	WI	Terminated
DSH520138AM	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SLM Physical Medicine Airport	2000 E Layton Ave	Saint Francis	WI	Terminated
DSH520138AN	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SLM Physical Medicine New Berlin	14555 West National Ave Suite 195	New Berlin	WI	Terminated
DSH520138AP	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SLM Physical Medicine Franklin	4020 West Oakwood Park Court Suite 340	Franklin	WI	Terminated
DSH520138AQ	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SLM Physical Medicine 60th Street	3738 south 60th st.	Milwaukee	WI	Terminated
DSH520138AR	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL ARC Miller Pkway	4111 West Mitchell Street Suite 300	Milwaukee	WI	Terminated
DSH520138AS	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL ARC Health Science 1	2901 W KK River Parkway Suite 500	Milwaukee	WI	Terminated
DSH520138AT	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Cardiac Consult	960 N 12th St.	Milwaukee	WI	Active
DSH520138AU	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Echo	960 N 12th St.	Milwaukee	WI	Active
DSH520138AV	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Cardiology Services	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138AW	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Arrhythmia Clinic	960 N 12th st.	Milwaukee	WI	Active
DSH520138AX	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / SATC	945 N 12th St.	Milwaukee	WI	Active
DSH520138AY	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS BH Partial Day Program	5900 South Lake Dr.	Cudahy	WI	Terminated
DSH520138AZ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL Surgery Center	2801 W KK River Parkway POB East LL60	Milwaukee	WI	Active
DSH520138BA	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Emergency Room	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138BB	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Emergency Room	945 N 12th St.	Milwaukee	WI	Active
DSH520138BC	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL Heart Failure Clinic	2801 W KK River Parkway Suite 575	Milwaukee	WI	Terminated
DSH520138BD	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL MS Clinic	2801 W KK River Parkway Suite 680, 480	Milwaukee	WI	Active
DSH520138BE	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora Sinai Medical Center / ASMC Downtown UC Imaging	946 N Van Buren St	Milwaukee	WI	Terminated
DSH520138BF	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Comp Breast Health	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138BG	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL Franklin Urgent Care	9200 West Loomis Road	Franklin	WI	Terminated
DSH520138BH	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL Cancer and Lymph	2801 W KK River Parkway Suite 160	Milwaukee	WI	Terminated
DSH520138BJ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Ambulatory Services	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138BK	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL Epilepsy	2801 W KK River Parkway Suite 550	Milwaukee	WI	Active
DSH520138BL	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Nutrition Services	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138BM	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL Pulmonary Sleep clinic	2801 W KK River Parkway Suite 468	Milwaukee	WI	Active
DSH520138BN	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL Sleep Disorders	4131 W Loomis Road Suite 220	Greenfield	WI	Active
DSH520138BP	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC GI Services	945 N 12th St.	Milwaukee	WI	Active
DSH520138BQ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS GI Services	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138BR	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Day Surgery	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138BS	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Day Surgery	945 N 12th St.	Milwaukee	WI	Active
DSH520138BT	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Pulmonary Med Diagnostics	945 N 12th St.	Milwaukee	WI	Active
DSH520138BU	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Interventional Lab	945 N 12th St.	Milwaukee	WI	Active
DSH520138BV	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Interventional Radiology	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138BW	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Hemodialysis	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138BX	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Neurodiagnostics	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138BY	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Neurodiagnostics	5900 South Lake Drive	Cudahy	WI	Terminated
DSH520138CA	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL OP Speech and Physical Medicine Neuroscience	2901 W KK River Parkway Health Science 1	Milwaukee	WI	Terminated
DSH520138CB	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Integrative Medicine	960 N 12th St.	Milwaukee	WI	Terminated
DSH520138CC	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS outpatient PT OT	5900 South Lake Drive	Cudahy	WI	Terminated
DSH520138CD	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC IRP PT OT	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138CE	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Acute PT OT	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138CF	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Respiratory Svcs	945 N 12th St.	Milwaukee	WI	Active
DSH520138CG	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Respiratory Svcs	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138CH	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC ACL	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138CK	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / SL Cardiac Specialty Clinic	2801 W KK River Parkway Suite 530	Milwaukee	WI	Active
DSH520138CL	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Interventional Cardiac Services	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138CM	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC MRI Services	945 N 12th St.	Milwaukee	WI	Active
DSH520138CN	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS MRI Services	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138CP	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC CT Svcs	945 N 12th St.	Milwaukee	WI	Active
DSH520138CQ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS CT Svcs	5900 South Lake Drive	Cudahy	WI	Active
DSH520138CR	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Nuclear Medicine	945 N 12th St.	Milwaukee	WI	Active
DSH520138CS	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Nuclear Medicine	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138CU	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Diagnostic Radiology	945 N 12th St.	Milwaukee	WI	Active
DSH520138CV	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Breast Imaging	945 N 12th St.	Milwaukee	WI	Active
DSH520138CW	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Ultrasound	945 N 12th St.	Milwaukee	WI	Active
DSH520138CX	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Ultrasound	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138CY	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St Luke's South Shore / SS Anesthesiology	5900 South Lake Dr.	Cudahy	WI	Terminated
DSH520138CZ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Anesthesiology	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138DB	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Labor and Delivery	945 N 12th St	Milwaukee	WI	Active
DSH520138DC	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA SINAI MEDICAL CENTER OF AURO / ASMC Wms Health and OB Svcs	945 N. 12TH STREET	MILWAUKEE	WI	Active
DSH520138DD	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA SINAI MEDICAL CENTER OF AURO / ASMC PACU	945 N 12TH ST	MILWAUKEE	WI	Active
DSH520138DE	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS PACU	5900 S LAKE DR	CUDAHY	WI	Active
DSH520138DF	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Operating Room	5900 S LAKE DRIVE	CUDAHY	WI	Active
DSH520138DG	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Operating Room	945 N 12TH STREET	MILWAUKEE	WI	Active
DSH520138DH	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Sleep Disorders	10600 N Port Washington Road	Mequon	WI	Active
DSH520138DJ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC outpatient PT OT	945 N 12th St.	Milwaukee	WI	Terminated
DSH520138DK	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / ASMC Radiation Oncology	945 N 12th St.	Milwaukee	WI	Active
DSH520138DL	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's South Shore / SS Diagnostic Radiology	5900 South Lake Dr.	Cudahy	WI	Active
DSH520138DM	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / Rehabilition Center - South Milwaukee - OP Rehab	3611 S Chicago St	South Milwaukee	WI	Terminated
DSH520138DN	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / SL ARC Muskego	S74 W16775 Janesville Road	Muskego	WI	Terminated
DSH520138DP	Child	DSH	AURORA HEALTH CARE METRO INC.	Aurora St. Luke's Medical Center / Aurora Rehabilitation Center - Greenfield	4131 W Loomis Road Suite 200	Greenfield	WI	Terminated
DSH520138DQ	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / Wound Care	945 North 12th Street	Milwaukee	WI	Active
DSH520138DR	Child	DSH	AURORA HEALTH CARE METRO, INC.	St. Luke's South Shore / Hemodialysis	5900 S Lake Drive	Cudahy	WI	Terminated
DSH520138DS	Child	DSH	AURORA HEALTH CARE METRO, INC.	St. Luke's South Shore / Behavioral Health - Intensive Outpatient	5900 S Lake Drive	Cudahy	WI	Terminated
DSH520138DT	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center - Sinai Downtown Pulmonary Clinic	960 N 12th St	Milwaukee	WI	Active
DSH520138DU	Child	DSH	AURORA HEALTH CARE METRO, INC.	St Luke's Medical Center/OP Rehab Satellite / SLM PMR Back and Spine	2901 W. Kinnickinnic Parkway Suite 310	Milwaukee	WI	Active
DSH520138DV	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center / Electrocardiology	960 N 12th St	Milwaukee	WI	Active
DSH520138DW	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Sinai Medical Center/SATC SOJOURNER	619 W. Walnut Street	Milwaukee	WI	Active
DSH520138DX	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Luke's Medical Center / International Care Clinic - SLM International Care	2801 W Kinnickinnic River Pkwy	Milwaukee	WI	Active
DSH520138DY	Child	DSH	AURORA HEALTH CARE METRO, INC.	SDT Internal Medicine Clinic - Internal Medicine	945 N 12th Street	Milwaukee	WI	Active
DSH520138DZ	Child	DSH	AURORA HEALTH CARE METRO, INC.	SDT Family Care Center - Family Care	945 N 12th Street	Milwaukee	WI	Active
DSH520138E	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO INC.-PHYSIATRY CLINIC	2901 W Kinnickinnic Parkway Suite 101	MILWAUKEE	WI	Active
DSH520138EA	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO - SL CLINIC FRANKLIN RHEUMATOLOGY	4225 W OAKWOOD PARK CT	FRANKLIN	WI	Active
DSH520138EB	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO INC - SDT CLINIC INTERNAL MEDICINE HOSPITAL OUTPATIENT DEPARTMENT	945 N 12TH ST	MILWAUKEE	WI	Terminated
DSH520138EC	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO INC - SDT FAMILY CARE CENTER HOSPITAL OUTPATIENT DEPARTMENT	945 N 12TH ST	MILWAUKEE	WI	Terminated
DSH520138ED	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora St. Lukes South Shore - Pain Management - Pain Management	5900 South Lake Dr	Cudahy	WI	Active
DSH520138F	Child	DSH	AURORA HEALTH CARE METRO, INC.	ARC- RIVERCENTER	1575 N. RIVERCENTER DR	MILWAUKEE	WI	Terminated
DSH520138G	Child	DSH	AURORA HEALTH CARE METRO, INC.	SPORTS MEDICINE-SINAI	945 N. 12TH STREET	MILWAUKEE	WI	Terminated
DSH520138H	Child	DSH	AURORA HEALTH CARE METRO, INC.	SPORTS MEDICINE- MEQUON	1249 W. LIEBAU ROAD	MEQUON	WI	Terminated
DSH520138I	Child	DSH	AURORA HEALTH CARE METRO, INC.	SPORTS MEDICINE- JCC	6255 N. SANTA MONICA BLVD	WHITEFISH BAY	WI	Terminated
DSH520138J	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO, INC.-MFM ULTRASOUND	945 NORTH 12TH STREET	MILWAUKEE	WI	Active
DSH520138K	Child	DSH	AURORA HEALTH CARE METRO, INC.	SPORTS MEDICINE-BLUEMOUND	16985 W. BLUEMOUND ROAD	BROOKFIELD	WI	Terminated
DSH520138L	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO, INC-IMAGING/FRANKLIN	9200 WEST LOOMIS ROAD	FRANKLIN	WI	Terminated
DSH520138M	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO, INC.-AUDIOLOGY-SOUTH SHORE	5900 SOUTH LAKE DRIVE	CUDAHY	WI	Terminated
DSH520138N	Child	DSH	AURORA HEALTH CARE METRO, INC.	AURORA HEALTH CARE METRO, INC.-ARC SOUTH SHORE	5900 SOUTH LAKE DRIVE	CUDAHY	WI	Terminated
DSH520138P	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	W180N11070 River Lane	Germantown	WI	Active
DSH520138Q	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro/ Neuro Oncology	2801 W Kinnickinnic River Pkwy Suite 960/980/480	Milwaukee	WI	Active
DSH520138R	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	1055 N. Mayfair Road	Milwaukee	WI	Active
DSH520138S	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	6811 118th Avenue	Kenosha	WI	Active
DSH520138T	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	N14 W23833 Stone Ridge Drive Suite 200	Waukesha	WI	Terminated
DSH520138U	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	8400 Washington Ave	Racine	WI	Active
DSH520138W	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	709 Spring Valley Road	Burlington	WI	Active
DSH520138Y	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	3003 W Good Hope Road	Milwaukee	WI	Active
DSH520138Z	Child	DSH	AURORA HEALTH CARE METRO, INC.	Aurora Cancer Care of Aurora Health Care Metro, Inc.	N84 W16889 Menomonee Avenue	Menomonee Falls	WI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Nelson, Nan SVP-Finance Advocate Aurora Health Care 4143784765	8/6/2024 1:31 PM
Details	340B ID	Update	New Registration		DSH520138ED	8/6/2024 1:31 PM
Details	Entity Name	Update	New Registration	AURORA HEALTH CARE METRO INC.	AURORA HEALTH CARE METRO, INC.	8/6/2024 1:31 PM
Details	Entity Subname	Update	New Registration	Aurora St. Lukes South Shore - Pain Management	Aurora St. Lukes South Shore - Pain Management - Pain Management	8/6/2024 1:31 PM
Dates	Participating Approval Date	Update	New Registration		8/6/2024 1:31:38 PM	8/6/2024 1:31 PM
Details	State	Update	New Registration	Pending	Approved	8/6/2024 1:31 PM
Dates	Signed By Date	Update	New Registration		7/8/2024 11:48:00 AM	8/6/2024 1:31 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/6/2024 1:31 PM
Contacts	Primary Contact	Update	Change Request	Nowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	Nowak, Jason G Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	7/22/2024 3:54 PM
Addresses	Main Address	Insert	New Registration		5900 South Lake Dr Cudahy, WI 53110	7/5/2024 12:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1861447179	7/5/2024 12:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		WI	7/5/2024 12:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1861447179	7/5/2024 12:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/5/2024 12:50 PM
Contacts	Authorizing Official	Insert	New Registration		Nelson, Nan SVP-Finance Advocate Aurora Health Care 4143784765	7/5/2024 12:50 PM
Contacts	Primary Contact	Insert	New Registration		Nowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	7/5/2024 12:50 PM
Details	Assistance Received From Date	Insert	New Registration			7/5/2024 12:50 PM
Details	Assistance Received To Date	Insert	New Registration			7/5/2024 12:50 PM
Details	Last Recertification Date	Insert	New Registration			7/5/2024 12:50 PM
Details	Grant Number	Insert	New Registration			7/5/2024 12:50 PM
Details	340B ID	Insert	New Registration			7/5/2024 12:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/5/2024 12:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/5/2024 12:50 PM
Details	Medicare Provider Number	Insert	New Registration		520138	7/5/2024 12:50 PM
Details	Entity Name	Insert	New Registration		AURORA HEALTH CARE METRO INC.	7/5/2024 12:50 PM
Details	NOFO Number	Insert	New Registration			7/5/2024 12:50 PM
Details	Program Code	Insert	New Registration		DSH	7/5/2024 12:50 PM
Details	Entity Subname	Insert	New Registration		Aurora St. Lukes South Shore - Pain Management	7/5/2024 12:50 PM
Dates	Participating Approval Date	Insert	New Registration			7/5/2024 12:50 PM
Details	State	Insert	New Registration		Pending	7/5/2024 12:50 PM
Dates	Registration Date	Insert	New Registration		7/5/2024 12:50:25 PM	7/5/2024 12:50 PM
Dates	Signed By Date	Insert	New Registration			7/5/2024 12:50 PM
Dates	Start Date	Insert	New Registration			7/5/2024 12:50 PM
Terminations	Termination Comments	Insert	New Registration			7/5/2024 12:50 PM
Terminations	Termination Date	Insert	New Registration			7/5/2024 12:50 PM
Terminations	Termination Effective Date	Insert	New Registration			7/5/2024 12:50 PM
Terminations	Termination Reason	Insert	New Registration			7/5/2024 12:50 PM