340B Drug Pricing Program Database


DSH520051 COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active) - information as of 4/25/2025 9:20:29 PM

Main Details
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
COLUMBIA ST MARYS HOSPITAL MILWAUKEE
Disproportionate Share Hospital
Yes
DSH520051
520051


Additional Details
Active
4/24/2006
4/1/2004
4/24/2006
8/26/2024

Contacts

Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374

Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533

Addresses

2323 N LAKE DRIVE
MILWAUKEE, WI 53211-4508

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
04/05/2012 medicaid # change added npi(was 52-0051); 4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE04/05/2012
4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE11/25/2008
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WI 1871656082,1023064482
Shipping Addresses

COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
2323 N LAKE DRIVE
MILWAUKEE, WI 53211-4508

Safecor Health, LLC
4060 Business Park Drive
Suite B
Columbus, OH 43204

Ascension RX
7701 Metropolis Drive
200C
Austin, TX 78744

Option Care
10101 Innovation Drive
Suite 200
Wauwatosa, WI 53226
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/26/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/26/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/26/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624110/26/201801/01/2019 08/01/202301/10/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/26/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/26/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/11/202204/01/2022  04/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/10/202404/01/2024  04/01/2024
Contract DetailAFFILIATED HEALTH SERVICES, INC.DBA ASCENSION RX 1303 30055 NORTHWESTERN HWY
STE 225 		FARMINGTON HILLSMI4833404/13/202007/01/2020 03/09/202204/14/2022
Contract DetailALTSCRIPTS SPECIALTY PHARMACY1636 MILLER PARK WAY
WEST MILWAUKEEWI53214-360410/26/201801/01/2019  01/01/2019
Contract DetailASCENSION PHARMACY SERVICES, LLCDBA ASCENSION RX 1303 30055 NORTHWESTERN HWY STE 225
FARMINGTON HILLSMI4833401/13/202201/26/2022  01/27/2022
Contract DetailASCENSION RX 1001ASCENSION PHARMACY SERVICES, LLC. 7701 METROPOLIS DR STE 200B
AUSTINTX78744-312507/16/202110/01/2021  10/01/2021
Contract DetailASCENSION RX 30017701 METROPOLIS DR STE 200C
AUSTINTX78744-312507/16/202110/01/2021 04/01/202210/14/2022
Contract DetailASCENSION WISCONSIN PHARMACY, INCDBA ASCENSION RX 1109 13133 N PORT WASHINGTON RD
MEQUONWI53097-241904/09/201907/01/2019  07/01/2019
Contract DetailASCENSION WISCONSIN PHARMACY, INCDBA ASCENSION RX 1112 2301 N LAKE DR
MILWAUKEEWI53211-450804/09/201907/01/2019  07/01/2019
Contract DetailASCENSION WISCONSIN PHARMACY, INCDBA ASCENSION RX 1115 (1112) 9252 N GREEN BAY RD
BROWN DEERWI53209-110401/13/202104/01/2021 05/06/202210/14/2022
Contract DetailASCENSION WISCONSIN PHARMACY, INC.DBA/ ASCENSION RX 1106 201 N MAYFAIR RD
WAUWATOSAWI53226-421601/10/202504/01/2025  04/01/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/17/202004/01/2020 10/31/202411/05/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/15/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/15/202001/01/2021  01/01/2021
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/15/202001/01/2021  01/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/15/202001/01/2021  01/01/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/15/202001/01/2021  01/01/2021
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/08/201704/01/2017 08/09/201708/09/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/29/201707/01/2017 12/30/202001/13/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/08/202010/01/2020 05/04/202205/19/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111210/26/201801/01/2019  01/01/2019
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/26/201801/01/2019  01/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607510/26/201801/01/2019  01/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801610/26/201801/01/2019  01/01/2019
Contract DetailGENOA HEALTHCARE LLC1501 AIRPORT RD STE 1072
WAUKESHAWI5318801/10/202404/01/2024  04/01/2024
Contract DetailGENOA HEALTHCARE LLCN171 W21840 CAYMUS CT
JACKSONWI5303701/10/202404/01/2024  04/01/2024
Contract DetailGENOA HEALTHCARE LLC10424 WEST BLUEMOUND ROAD SUITE B
MILWAUKEEWI5322601/10/202404/01/2024  04/01/2024
Contract DetailHOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06648 655 S. US HIGHWAY 31
GREENWOODIN4614207/13/202110/01/2021  10/01/2021
Contract DetailMETRO MARKET PHARMACY #63711123 NORTH VAN BUREN STREET
MILWAUKEEWI5320210/14/201901/01/2020 12/05/202201/12/2023
Contract DetailMETRO MARKET PHARMACY #689011558 N PORT WASHINGTON RD
MEQUONWI5309210/14/201901/01/2020 12/05/202201/12/2023
Contract DetailMETRO MARKET PHARMACY #68934075 N OAKLAND AVE
SHOREWOODWI5321110/14/201901/01/2020 12/05/202201/12/2023
Contract DetailMINISTRY HOME CARE SERVICES, LLCASCENSION AT HOME 10050 S 27TH ST STE 100
OAK CREEKWI53154-552004/14/202307/01/2023  07/01/2023
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/08/202010/01/2020 10/01/202004/13/2021
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191309/14/202310/01/2023  10/01/2023
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260109/14/202310/01/2023  10/01/2023
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135107/08/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276507/13/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705807/13/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/13/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/29/202205/03/2022  05/04/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/10/202404/01/2024  04/01/2024
Contract DetailOPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/10/202404/01/2024  04/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/08/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/08/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970507/08/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265507/13/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/08/202010/01/2020  10/01/2020
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/08/202010/01/2020  10/01/2020
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/08/202010/01/2020 05/27/202209/14/2023
Contract DetailPICK 'N SAVE PHARMACY #6357ULTRA MART FOODS, LLC N112 W16200 MEQUON ROAD
GERMANTOWNWI5302210/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK 'N SAVE PHARMACY #68574698 SOUTH WHITNALL AVENUE
ST. FRANCISWI5323510/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK 'N SAVE PHARMACY #68679200 N. GREEN BAY ROAD
BROWN DEERWI5320910/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK 'N SAVE PHARMACY 6879MEGA MARTS, LLC 2355 N. 35TH STREET
MILWAUKEEWI5321010/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK 'N SAVE PHARMACY 6880MEGA MARTS, LLC 1735 W. SILVER SPRING DRIVE
GLENDALEWI5320910/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK 'N SAVE PHARMACY 6882MEGA MARTS, LLC 1100 E. GARFIELD
MILWAUKEEWI5321210/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK N SAVE PHARMACY #63486462 S 27TH ST
OAK CREEKWI5315410/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK N SAVE PHARMACY #68462625 S 108TH ST
WEST ALLISWI5322710/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK N SAVE PHARMACY #6878250 W HOLT AVE
MILWAUKEEWI5320710/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPICK N SAVE PHARMACY #6886301 FALLS ROAD
GRAFTONWI5302410/14/201901/01/2020 12/05/202201/12/2023
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/11/201710/01/2017 12/30/202001/13/2021
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/15/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/15/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/15/202001/01/2021  01/01/2021
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/17/202004/01/2020 10/31/202411/05/2024
Contract DetailSETON PHARMACY, COLUMBIA ST. MARYS HOSPI  2323 NORTH LAKE DRIVE
MILWAUKEEWI5321110/01/200410/01/2004 12/01/201508/03/2017
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022307/16/202410/01/2024  10/01/2024
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104207/16/202410/01/2024  10/01/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-139410600 W LAYTON AVE
GREENFIELDWI5322810/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-2452401 E. CAPITOL DRIVE
MILWAUKEEWI5321203/05/201203/09/2012 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-293610330 W SILVER SPRINGS DR
MILWAUKEEWI5322510/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281910/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-56977025 W MAIN ST
MILWAUKEEWI5321410/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWALGREEN CODBA: WALGREENS #10963 6101 W GREENFIELD AVE
WEST ALLISWI5321404/08/201707/01/2017  08/03/2017
Contract DetailWalgreen CODBA Walgreens Central Fill #21417 599 S Schmidt Rd
Ste A 		BolingbrookIL60440-940501/12/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 00295 4808 N HOPKINS
MILWAUKEEWI5320904/18/201607/01/2016 11/08/202212/06/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 00649 3701 S HOWELL AVE
MILWAUKEEWI5320704/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00665 1600 W WISCONSIN
MILWAUKEEWI5323304/18/201607/01/2016 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 01200 275 W WISCONSIN AVE
MILWAUKEEWI5320304/18/201607/01/2016 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 01652 3109 S KINNICKINNIC
MILWAUKEEWI5320704/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 01685 1400 EAST BRADY
MILWAUKEEWI5320204/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #21396 320 E CAPITOL DR
MILWAUKEEWI5321204/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02296 2727 W NORTH AVE
MILWAUKEEWI5320804/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02911 6292 S 27TH STREET
MILWAUKEEWI5322104/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02925 5115 WEST CAPITOL DR
MILWAUKEEWI5321604/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03109 7171 N. TEUTONIA AVENUE
MILWAUKEEWI5320904/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03394 9100 W BELOIT RD
MILWAUKEEWI5322704/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03509 620 W OKLAHOMA AVE
MILWAUKEEWI5321504/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03578 2275 NORTH MAYFAIR ROAD
WAUWATOSAWI5322604/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03666 4405 W LAYTON AVE
GREENFIELDWI5322004/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03732 2985 S CHICAGO AVE
SOUTH MILWAUKEEWI5317204/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03813 3522 W WISCONSIN
MILWAUKEEWI5320804/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03883 221 E SUNSET DR
WAUKESHAWI5318904/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04253 2656 N WAUWATOSA AVE
WAUWATOSAWI5321304/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04350 3233 SOUTH 27TH ST
MILWAUKEEWI5321504/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04537 7600 W CAPITOL DRIVE
MILWAUKEEWI5322204/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04720 2222 W. CAPITOL
MILWAUKEEWI5320604/18/201607/01/2016 01/15/202401/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04774 8333 W GREENFIELD AVE
WEST ALLISWI5321404/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04887 9449 S HOWELL AVE
OAK CREEKWI5315404/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04984 6707 W. HAMPTON AVE.
MILWAUKEEWI5321804/18/201607/01/2016 10/26/202310/31/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05231 10725 W GREENFIELD AVE
WEST ALLISWI5321404/18/201607/01/2016 09/12/201910/07/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05601 4730 S 27TH STREET
MILWAUKEEWI5322104/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06020 6030 W OKLAHOMA AVE
MILWAUKEEWI5321904/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06058 4296 S 76TH STREET
GREENFIELDWI5322004/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07370 6442 N 76TH STREET
MILWAUKEEWI53223-610204/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07568 5860 S 108TH STREET
HALES CORNERSWI5313004/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07809 2625 W NATIONAL AVE
MILWAUKEEWI53204-106804/18/201607/01/2016 11/13/202411/25/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09066 3201 E LAYTON AVE
CUDAHYWI5311004/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09549 5400 N PORT WASHINGTON RD
GLENDALEWI5321704/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09839 6241 S PACKARD AVE
CUDAHYWI5311004/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 10196 6600 WEST STATE STREET
WAUWATOSAWI5321304/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #10873 2950 N. OAKLAND AVE.
MILWAUKEEWI53211-322804/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #15188 4035 N OAKLAND AVE
SHOREWOODWI5321104/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #15322 826 N PLANKINTON AVE STE 100
MILWAUKEEWI5320304/18/201607/01/2016  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 01988 1915 WISCONSIN AVE
GRAFTONWI5302404/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02110 829 E GREEN BAY AVE
SAUKVILLEWI53080-261804/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02752 15350 WEST BLUEMOUND RD
ELM GROVEWI5312204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03125 8615 N PORT WASHINGTON
FOX POINTWI5321704/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03448 11270 N PORT WASHINGTON RD
MEQUONWI5309204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03567 1021 SUMMIT AVE.
OCONOMOWOCWI5306604/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03615 21325 E. MORELAND BLVD.
WAUKESHAWI5318604/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03882 2677 S 108TH ST
WEST ALLISWI5322704/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04095 10800 W. CAPITOL
WAUWATOSAWI5322204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04254 5201 N. 91ST STREET
MILWAUKEEWI5322504/08/201707/01/2017 12/03/202401/10/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 04471 9040 W GOOD HOPE RD
MILWAUKEEWI5322404/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04556 6210 W LOOMIS
GREENDALEWI5312904/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04672 2205 N CALHOUN RD
BROOKFIELDWI5300504/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04827 4688 S. 108TH STREET
GREENFIELDWI5322804/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04884 278 N MAIN STREET
THIENSVILLEWI5309204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04888 15650 W GREENFIELD AVE
BROOKFIELDWI5300504/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05002 N83W15701 APPLETON AVE
MENOMONEE FALLSWI5305104/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05281 2901 GOLF RD
DELAFIELDWI5301804/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05309 1441 CAPITOL DRIVE
PEWAUKEEWI5307204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05427 W156 N11261 PILGRIM ROAD
GERMANTOWNWI5302204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05459 9909 W LOOMIS ROAD
FRANKLINWI5313204/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05884 9527 S 27TH ST
FRANKLINWI5313204/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06243 5005 DOUGLAS AVE
RACINEWI53402-202704/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06960 1400 E SUMNER STREET
HARTFORDWI53027-260504/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07039 212 N ROCHESTER STREET
MUKWONAGOWI5314904/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07143 N56W15501 SILVER SPRING DR
MENOMONEE FALLSWI53051-597104/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07259 3855 SOUTH MOORLAND
NEW BERLINWI53151-522504/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07603 S79 W18885 JANESVILLE ROAD
MUSKEGOWI53150-939004/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07661 2410 W FOREST HOME AVE
MILWAUKEEWI53215-252704/08/201707/01/2017 10/10/202310/10/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07730 2700 N GRANDVIEW BLVD
WAUKESHAWI53188-161104/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07731 N65W25055 MAIN STREET
SUSSEXWI5308904/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.W002:DBA WALGREENS #07797 15640 W CAPITOL DR
BROOKFIELDWI53005-222104/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09365 423 MERTON AVE
HARTLANDWI53029-150604/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #11237 1433 W. BURNHAM ST.
MILWAUKEEWI5320404/08/201707/01/2017 04/01/202404/04/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #11676 N168W21330 MAIN ST.
JACKSONWI5303704/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #12524 6020 W. BROWN DEER RD.
BROWN DEERWI5322304/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #12783 2826 N. MARTIN LUTHER KING DR.
MILWAUKEEWI53212-231404/08/201707/01/2017 12/05/202401/10/2025
Contract DetailWALGREEN CO.DBA: WALGREENS #13088 1921 S. MAIN ST.
WEST BENDWI53095-520604/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #13620 W62N190 WASHINGTON AVE.
CEDARBURGWI5301204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #13683 1720 W. WASHINGTON ST.
WEST BENDWI53095-231104/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 15020 7130 S. 76TH ST
FRANKLINWI5313204/08/201707/01/2017  08/03/2017
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #21254 2265 N MAYFAIR RD.
WAUWATOSAWI5322601/10/202004/01/2020  04/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS #11636 S70W15775 JANESVILLE RD.
MUSKEGOWI53150-794701/12/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.W002:DBA WALGREENS #07797 15640 W CAPITOL DR
BROOKFIELDWI53005-222101/10/202504/01/2025  04/01/2025
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/08/201704/01/2017  08/03/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/08/201704/01/2017 12/30/202001/13/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/08/201704/01/2017  08/03/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/08/201704/01/2017 12/30/202001/13/2021
Contract DetailWALMART PHARMACY 10-63946300 W BROWN DEER ROAD
BROWN DEERWI5322310/09/201801/01/2019 11/28/202302/16/2024
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08763 1650 FARWELL
MILWAUKEEWI5320201/09/201404/01/2014  08/03/2017
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08768 240 E HAMPTON AVENUE
WHITEFISH BAYWI5321701/09/201404/01/2014  08/03/2017
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 17043 8989 S HOWELL AVE
OAK CREEKWI5315410/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.TARGET PHARMACY # 17584 3900 N 124TH ST
WAUWATOSAWI5322210/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 16654 4798 S MOORLAND RD
NEW BERLINWI5315110/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06855 17165 BLUEMOUND RD.
BROOKFIELDWI5300510/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 17015 1501 MILLER PARK WAY
WEST MILWAUKEEWI5321410/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 17277 2600 S 108TH ST
WEST ALLISWI5322710/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08772 5740 S PACKARD AVE
CUDAHYWI5311010/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5676 7552 W. OKLAHOMA AVE.
WEST ALLISWI5321910/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08771 7520 W BLUE MOUND RD
WAUWATOSAWI5321310/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05390 5220 WEST RAWSON AVE.
FRANKLINWI5313210/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08767 2607 N. DOWNER AVE.
MILWAUKEEWI5321110/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03394 3860 S. 27TH ST.
MILWAUKEEWI5322110/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08762 1316 W FOREST HOME AVE
MILWAUKEEWI5320410/15/202001/01/2021 03/04/202103/06/2025
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08775 W63-N152 WASHINGTON AVE
CEDARBURGWI5301210/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08765 9220 W GREENFIELD
WEST ALLISWI5321410/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08769 5929 WEST LISBON AVE
MILWAUKEEWI5321010/15/202001/01/2021 07/10/202309/22/2023
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01267 7550 W. PERKINS PLACE
MILWAUKEEWI5321610/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 16059 2950 S CHASE AVE
MILWAUKEEWI5320710/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 16301 N95 W 17707 SHADY LN
MENOMONEE FALLSWI5305110/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08773 3030 W VILLARD AVE
MILWAUKEEWI5320910/15/202001/01/2021 01/22/202503/06/2025
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08770 8661 N PORT WASHINGTON
FOX POINTWI5321710/15/202001/01/2021  01/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 17451 7800 S LOVERS LANE RD
FRANKLINWI5313204/15/202107/01/2021  07/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 4996 N83W15550 APPLETON AVE
MENOMONEE FALLSWI53051-371404/15/202107/01/2021  07/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 16567 1250 N PORT WASHINGTON RD
GRAFTONWI5302404/15/202107/01/2021  07/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 16020 2401 KOSSOW RD
WAUKESHAWI5318607/13/202110/01/2021  10/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08947 1130 W. SUNSET DR.
WAUKESHAWI5318907/13/202110/01/2021  10/01/2021
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.CVS PHARMACY # 17633 12725 W BLUEMOUND RD
BROOKFIELDWI5300504/11/202307/01/2023  07/01/2023
Contract DetailWISCONSIN CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #17823 5701 N LYNDELL AVENUE
GLENDALEWI5321704/11/202307/01/2023  07/01/2023
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH520051AAChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Green Bay Road - Radiology9252 N. Green Bay RoadBrown DeerWITerminated
DSH520051ABChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCBay View Family Health Center - Rehab3056 S. Kinnickinnic Ave.Bay ViewWITerminated
DSH520051ACChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Green Bay Road - Rehab9233 N. Green Bay RoadBrown DeerWITerminated
DSH520051ADChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Green Bay Road - Surgery9252 N. Green Bay Rd.Brown DeerWITerminated
DSH520051AEChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Mequon13133 N. Port Washington RoadMequonWIActive
DSH520051AFChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Bay View3056 S. Kinnickinnic Ave.Bay ViewWIActive
DSH520051AGChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Milwaukee2350 N. Lake Dr.MilwaukeeWIActive
DSH520051AHChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCWestgate Medical Group2727 N Mayfair RoadWauwatosaWITerminated
DSH520051AIChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCBay View Family Health Center3056 S. Kinnickinnic Ave.Bay ViewWIActive
DSH520051AJChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCWest Allis Medical Clinic2323 S. 102nd St.West AllisWIActive
DSH520051AKChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Green Bay Road9252 N. Green Bay Rd.Brown DeerWIActive
DSH520051ALChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Port Washington Road6900 N. Port Washington Rd.GlendaleWIActive
DSH520051AMChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCColumbia West - Rehab10950 W. Capitol Dr.WauwatosaWITerminated
DSH520051ANChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCColumbia West - Radiology10950 W. Capitol Dr.WauwatosaWITerminated
DSH520051APChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGateway Medical Clinic - Rehab801 S. 70th St.West AllisWITerminated
DSH520051AQChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGateway Medical Clinic - Radiology801 S. 70th St.West AllisWITerminated
DSH520051ARChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGateway Medical Clinic801 S. 70th St.West AllisWIActive
DSH520051ASChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - GI2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051ATChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCWater Tower Medical Commons - GYN Oncology2350 N. Lake Dr.MilwaukeeWIActive
DSH520051AUChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Radiology2311 N. Prospect Ave.MilwaukeeWITerminated
DSH520051AVChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Surgery2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051AWChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons2311 N. Prospect Ave.MilwaukeeWITerminated
DSH520051AXChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Perioperative375 W. River Woods PkwyGlendaleWITerminated
DSH520051AYChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Surgery Ambulatory375 W. River Woods PkwyGlendaleWITerminated
DSH520051AZChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - GI Lab375 W. River Woods PkwyGlendaleWIActive
DSH520051BChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMCP OZAUKEE CANCER CLINIC13111 NORTH PORT WASHINGTON ROADMEQUONWIActive
DSH520051BAChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Radiology Womens Imaging375 W. River Woods PkwyGlendaleWITerminated
DSH520051BBChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Radiology MRI375 W. River Woods PkwyGlendaleWITerminated
DSH520051BCChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Radiology Ultrasound375 W. River Woods PkwyGlendaleWITerminated
DSH520051BDChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Radiology CT Scan375 W. River Woods PkwyGlendaleWITerminated
DSH520051BEChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM River Woods - Radiology Diagnostic375 W. River Woods PkwyGlendaleWITerminated
DSH520051BFChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCColumbia West10950 W. Capitol Dr.WauwatosaWIActive
DSH520051BGChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMM Gateway Clinic / GI, Urology, Pain801 S. 70th St.West AllisWIActive
DSH520051BHChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCRiverwoods Urgent Care375 W. River Woods PkwyGlendaleWIActive
DSH520051BJChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons / Urology2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051BKChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCColumbia West / Integrative Medicine10950 W. Capitol Dr.WauwatosaWITerminated
DSH520051BLChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGateway Medical Clinic / Integrative Medicine801 S. 70th St.West AllisWITerminated
DSH520051BMChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Neurology Milwaukee2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051BNChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM PMC Neurology/SMO13133 N. Port Washington RdMequonWIActive
DSH520051BPChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Podiatry2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051BQChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Allergy / Allergy2311 N. Prospect Ave.MilwaukeeWITerminated
DSH520051BRChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEEProspect Medical Commons / Cadiology2311 N. Prospect Ave.MilwaukeeWITerminated
DSH520051BSChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons / Pulmonary2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051BTChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons / Internal Medicine2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051BUChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Family Practice2311 N PROSPECT AVEMILWAUKEEWIActive
DSH520051BVChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCOLUMBIA ST MARYS HOSPITAL MILWAUKE / Prospect Medical Commons - Express Care2311 N PROSPECT AVEMILWAUKEEWITerminated
DSH520051BWChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - OB/GYN2311 N PROSPECT AVEMILWAUKEEWIActive
DSH520051BXChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCProspect Medical Commons - Pediatrics2311 N PROSPECT AVEMILWAUKEEWIActive
DSH520051BYChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCOLUMBIA ST MARYS HOSPITAL MILWAUKE / Prospect Medical Commons - Pain Management2311 N PROSPECT AVEMILWAUKEEWIActive
DSH520051BZChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Radiation Oncology2350 N LAKE DRMILWAUKEEWIActive
DSH520051CChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCAirport Medical Clinic4848 S. 6th StreetMilwaukeeWITerminated
DSH520051CAChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardio Vasc Interventional Specialties13133 N PORT WASHINGTON RDMEQUONWIActive
DSH520051CBChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC90.02/Water Tower Medical Commons/6000642650/WTMC Urology Clinic2350 N LAKE DRMILWAUKEEWITerminated
DSH520051CCChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC6000554904/Cancer Center MDC SMO13111 N. Port Washington Rd.MequonWIActive
DSH520051CDChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC6000554903/Cancer Center MDC SMM2350 N LAKE DRMILWAUKEEWIActive
DSH520051CEChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC90.26 CATHEDRAL SQUARE CLINIC / 6000632401 URGENT CARE734 North Jackson St.MilwaukeeWITerminated
DSH520051CFChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC55/Radiology - Therapeutic/6000516290/Radiation Oncology Anc 0012350 N LAKE DRMILWAUKEEWIActive
DSH520051CGChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiothoracic Surgery WTMC/ 6000648007 - Cardiothoracic Surgery2350 N LAKE DRMilwaukeeWITerminated
DSH520051CHChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiothoracic Surgery SMO/ 6000648007 - Cardiothoracic Surgery13133 N. Port Washington RoadMequonWITerminated
DSH520051CJChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Heart Failure Clinic/SMO13133 N. Port Washington RoadMequonWIActive
DSH520051CKChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCPMC Neurosurgery Clinic2311 N. Prospect AveMilwaukeeWIApproved
DSH520051CLChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCPMC - Podiatry (Gateway) 6000647702 - Podiatry801 S. 70th St.West AllisWITerminated
DSH520051CMChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Shorewood Clinic/OB4027 North Oakland AveShorewoodWITerminated
DSH520051CNChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCChemotherapy (SMO) 6000516401 - Chemotherapy13111 N. Port Washington Rd.MequonWIActive
DSH520051CPChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Thoracic Surgery2350 N. Lake Dr.MilwaukeeWIActive
DSH520051CQChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM PMC Specialty Services/Nephrology2311 N Prospect AveMilwaukeeWITerminated
DSH520051CRChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCChemotherapy (Water Tower Medical Commons) 6000516400 - Chemotherapy2350 N. Lake Dr.MilwaukeeWIActive
DSH520051CSChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCStroke Clinic 6000653704 - Stroke2350 N. Lake Dr.MilwaukeeWITerminated
DSH520051CTChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac & Vascular Interventional Specialties - Cardiac & Vascular Interventional2350 N. Lake DriveMilwaukeeWIActive
DSH520051CUChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCPMC Behavioral Health - Behavioral Health2311 N. Prospect Ave.MilwaukeeWIActive
DSH520051CVChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Behavioral Health - Behavioral Medicine13111 N. Port Washington Rd.MequonWIActive
DSH520051CWChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Grafton - CLINIC2061 Cheyenne Ct.GraftonWITerminated
DSH520051CXChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Mammography - Radiology-Diagnostic13111 N. Port Washington Rd.MequonWIActive
DSH520051CYChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Diagnostic Cardiology - Electrocardiology13111 N. Port Washington Rd.MequonWIActive
DSH520051CZChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Testing and Treatment - Testing & Treatment13111 N. Port Washington Rd.MequonWIActive
DSH520051DAChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Surgery - Operating Room13111 N. Port Washington Rd.MequonWIActive
DSH520051DBChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Cardiac Rehabilitation - Cardiac Rehabilitation13111 N. Port Washington Rd.MequonWIActive
DSH520051DCChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Hyperbaric Oxygen - Hyperbaric Oxygen Therapy13111 N. Port Washington Rd.MequonWIActive
DSH520051DDChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Cardiac Cath Labs - Cardiac Catheterization13111 N. Port Washington Rd.MequonWIActive
DSH520051DEChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Nuclear Medicine - Radioisotope13111 N. Port Washington Rd.MequonWIActive
DSH520051DFChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital MRI - MRI13111 N. Port Washington Rd.MequonWIActive
DSH520051DGChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Respiratory Therapy - Respiratory Therapy13111 N. Port Washington Rd.MequonWIActive
DSH520051DHChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Emergency Department - Emergency13111 N. Port Washington Rd.MequonWIActive
DSH520051DJChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Interventional Radiology - Radiology-Diagnostic13111 N. Port Washington Rd.MequonWIActive
DSH520051DKChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCPMC Epilepsy Clinic2311 N. Prospect AveMilwaukeeWIActive
DSH520051DLChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Grafton Medical Clinic - CLINIC2061 Cheyenne Ct.GraftonWIActive
DSH520051DMChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Radiation Oncology - Radiology-Therapeutic13111 N. Port Washington Rd.MequonWIActive
DSH520051DNChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Anesthesiology - Anesthesiology13111 N. Port Washington Rd.MequonWIActive
DSH520051DPChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Ultrasound - Radiology-Diagnostic13111 N. Port Washington Rd.MequonWIActive
DSH520051DQChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cedar Mills Clinic - CLINICN143W6515 Pioneer Rd.CedarburgWIActive
DSH520051DRChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Grafton Urgent Care - CLINIC2061 Cheyenne Ct.GraftonWIActive
DSH520051DSChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Meadowview OBGYN Clinic - CLINIC13133 N. Port Washington Rd.MequonWIActive
DSH520051DTChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Bariatric Services - Bariatric Center13111 N. Port Washington Rd.MequonWIActive
DSH520051DUChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Perioperative Care - Operating Room13111 N. Port Washington Rd.MequonWIActive
DSH520051DVChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital GI Lab - GI Lab13111 N. Port Washington Rd.MequonWIActive
DSH520051DWChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Surgery Recovery Room - Recovery Room13111 N. Port Washington Rd.MequonWIActive
DSH520051DXChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital LDRPN Unit - Labor & Delivery13111 N. Port Washington Rd.MequonWIActive
DSH520051DYChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Greenlane Clinic - CLINIC830 E. Green Bay Ave.SaukvilleWIActive
DSH520051DZChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Germantown Clinic - CLINICN112W15415 Mequon Rd.GermantownWIActive
DSH520051EChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCENT Associates - Milwaukee2311 N PROSPECT AVEMilwaukeeWIActive
DSH520051EAChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Diagnostic Radiology - Radiology-Diagnostic13111 N. Port Washington Rd.MequonWIActive
DSH520051EBChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cedarburg Clinic - CLINICW62N179 Washington Ave.CedarburgWIActive
DSH520051ECChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital CT - CT Scan13111 N. Port Washington Rd.MequonWIActive
DSH520051EDChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Gateway / OBGYN - Clinic801 S. 70th St.West AllisWITerminated
DSH520051EEChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSMO Hospital Wound Care - Wound Care13111 N. Port Washington Rd.MequonWIActive
DSH520051EFChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cedar Mills / Radiology - ClinicN143W6515 Pioneer Rd.CedarburgWITerminated
DSH520051EGChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Airport / Urology - Clinic4848 S. 6th St.MilwaukeeWITerminated
DSH520051EHChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Grafton / Behavioral Medicine - Behavioral Medicine2061 Cheyenne Ct.GraftonWIActive
DSH520051EJChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Bay View / Pain Management - Clinic3056 S. Kinnickinnic Ave.Bay ViewWIActive
DSH520051EKChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Airport / Podiatry - Clinic4848 S. 6th St.MilwaukeeWITerminated
DSH520051ELChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM West Allis / Pain Management - Clinic2323 S. 102nd St.West AllisWIActive
DSH520051EMChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM WTMC Heart Failure Clinic - Clinic2350 N. Lake Dr.MilwaukeeWIActive
DSH520051ENChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Shorewood / Radiology - Clinic4027 N. Oakland Ave.ShorewoodWITerminated
DSH520051EPChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Germantown / Pain Management - ClinicN112 W15415 Mequon Rd.GermantownWIActive
DSH520051EQChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Gateway / Neurology - Clinic801 S. 70th St.West AllisWIActive
DSH520051ERChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Gateway / Pain Management - Clinic801 S. 70th St.West AllisWIActive
DSH520051ESChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Glendale GB / Behavioral Medicine - Behavioral Medicine9252 N. Green Bay Rd.Brown DeerWIActive
DSH520051ETChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Germantown / Radiology - ClinicN112 W15415 Mequon Rd.GermantownWITerminated
DSH520051EUChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Greenlane / Radiology - Clinic830 E. Green Bay Ave.SaukvilleWITerminated
DSH520051EVChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Grafton / Radiology - Clinic2061 Cheyenne Ct.GraftonWITerminated
DSH520051EWChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Gateway / Behavioral Medicine - Behavioral Medicine801 S. 70th St.West AllisWIActive
DSH520051EXChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM WTMC Surgical Oncology - Surgical Oncology2350 N. Lake Dr.MilwaukeeWIActive
DSH520051EYChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardio Vasc Intervent - Bay View - Cardiovascular3056 S. Kinnickinnic Ave.Bay ViewWIActive
DSH520051FChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCENT Associates - Ozaukee13133 N. Port Washington RdMequonWIActive
DSH520051GChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCancer Center - Milwaukee2350 N. Lake DriveMilwaukeeWIActive
DSH520051HChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCFamily Health Center1121 E. North Ave.MilwaukeeWIActive
DSH520051JChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac & Vascular Interventional Specialties 2301 N. Lake DriveMilwaukeeWITerminated
DSH520051KChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac Rhythm Specialists - Milwaukee2350 N. Lake DriveMilwaukeeWIActive
DSH520051LChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac Rhythm Specialists - Bay View3056 S. Kinnickinnic AvenueBay ViewWIActive
DSH520051MChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac Rhythm Specialists - Gateway801 S. 70th St.West AllisWIActive
DSH520051NChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCardiac Rhythm Specialists - Mequon13133 N. Port Washington RoadMequonWIActive
DSH520051PChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCShorewood Family Physicians4027 N. Oakland Ave.ShorewoodWIActive
DSH520051QChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCColumbia St. Mary's Hospital Ozaukee - Suite 20613133 N. Port Washington Rd.MequonWIActive
DSH520051SChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCathedral Square Rehab734 N. Jackson St.MilwaukeeWITerminated
DSH520051TChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Mequon - Radiology13133 N. Port Washington Rd.MequonWITerminated
DSH520051UChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Bay View - Radiology3056 S. Kinnickinnic Ave.Bay ViewWITerminated
DSH520051VChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCCSM Cardiovascular Specialists - Milwaukee - Radiology2350 N. Lake Dr.MilwaukeeWITerminated
DSH520051WChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCWestgate Medical Group - Radiology2727 N Mayfair RdWauwatosaWITerminated
DSH520051XChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCWest Allis Medical Clinic - Radiology2323 S. 102nd St.West AllisWITerminated
DSH520051YChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCAirport Medical Clinic - Radiology4848 S. 6th St.MilwaukeeWITerminated
DSH520051ZChildDSHCOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INCGlendale Clinic - Port Washington Road - Radiology6900 N. Port Washington RoadGlendaleWITerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Option Care 10101 Innovation Drive Suite 200 Wauwatosa, WI 532264/8/2025 11:16 AM
AddressesShipping AddressInsertChange Request Ascension RX 7701 Metropolis Drive 200C Austin, TX 787449/27/2024 8:56 AM
DetailsLast Recertification DateUpdateRecertification8/23/2023 1:33:58 PM8/26/2024 4:19:28 PM8/26/2024 4:19 PM
ContactsAuthorizing OfficialUpdateChange RequestFreitag, Vanessa Vice President, Pharmacy Ascension 7158971183Storey, Andre President Ascension Columbia St. Mary's 41458513744/9/2024 10:06 AM
ContactsPrimary ContactUpdateProfile Change RequestSmith-Jenkins, Cescilly 340B Program Director – Wisconsin Ascension WI 4144996174Smith-Jenkins, Cescilly 340B Program Director – Wisconsin Ascension WI 414522753311/28/2023 2:37 PM
DetailsLast Recertification DateUpdateRecertification9/15/2022 1:19:08 PM8/23/2023 1:33:58 PM8/23/2023 1:33 PM
Medicaid BillingMedicaid: NumberDeleteChange Request390806315001 (IL) 12/6/2022 12:12 PM
Medicaid BillingMedicaid: NumberDeleteChange Request11010300 (WI) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1871656082 (IL) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1871656082 (MI) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1871656082 (MN) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1023064482 (IL) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1023064482 (MI) 12/6/2022 12:12 PM
Medicaid BillingNPI: NumberDeleteChange Request1023064482 (MN) 12/6/2022 12:12 PM
DetailsLast Recertification DateUpdateRecertification9/8/2021 12:35:25 PM9/15/2022 1:19:08 PM9/15/2022 1:19 PM
Medicaid BillingNPI: NumberInsertChange Request 10230644826/10/2022 11:13 AM
Medicaid BillingNPI: StateInsertChange Request WI6/10/2022 11:13 AM
Medicaid BillingNPI: NumberInsertChange Request 10230644826/10/2022 11:13 AM
Medicaid BillingNPI: StateInsertChange Request IL6/10/2022 11:13 AM
Medicaid BillingNPI: NumberInsertChange Request 10230644826/10/2022 11:13 AM
Medicaid BillingNPI: StateInsertChange Request MI6/10/2022 11:13 AM
Medicaid BillingNPI: NumberInsertChange Request 10230644826/10/2022 11:13 AM
Medicaid BillingNPI: StateInsertChange Request MN6/10/2022 11:13 AM
DetailsLast Recertification DateUpdateRecertification9/10/2020 9:24:29 AM9/8/2021 12:35:25 PM9/8/2021 12:35 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestFreitag, Vanessa Vice President, Ambulatory Services and Operational Integration Ascension 4144653711Freitag, Vanessa Vice President, Pharmacy Ascension 71589711831/14/2021 3:35 PM
ContactsPrimary ContactUpdateProfile Change RequestSmith-Jenkins, Cescilly Regional Director, 340B Pharmacy Ascension WI 4148746268Smith-Jenkins, Cescilly 340B Program Director – Wisconsin Ascension WI 414499617410/15/2020 7:25 PM
DetailsLast Recertification DateUpdateRecertification9/10/2019 4:21:09 PM9/10/2020 9:24:29 AM9/10/2020 9:24 AM
Medicaid BillingNPI: NumberInsertChange Request 18716560828/6/2020 5:39 PM
Medicaid BillingNPI: StateInsertChange Request IL8/6/2020 5:39 PM
Medicaid BillingNPI: NumberInsertChange Request 18716560828/6/2020 5:39 PM
Medicaid BillingNPI: StateInsertChange Request MI8/6/2020 5:39 PM
Medicaid BillingNPI: NumberInsertChange Request 18716560828/6/2020 5:39 PM
Medicaid BillingNPI: StateInsertChange Request MN8/6/2020 5:39 PM
DetailsLast Recertification DateUpdateRecertification8/16/2018 4:52:04 PM9/10/2019 4:21:09 PM9/10/2019 4:21 PM
AddressesShipping AddressDeleteChange RequestCOLUMBIA ST MARY'S SETON PHARMACY 2323 N LAKE DRIVE MILWAUKEE, WI 53211 4/10/2019 10:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/2/2019 5:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3908063150011/2/2019 5:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IL1/2/2019 5:30 PM
DetailsLast Recertification DateUpdateRecertification11/16/2017 11:02:48 AM8/16/2018 4:52:04 PM8/16/2018 4:52 PM
AddressesShipping AddressInsertChange Request COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC 2323 N LAKE DRIVE MILWAUKEE, WI 53211-45087/13/2018 11:59 AM
AddressesShipping AddressInsertChange Request Safecor Health, LLC 4060 Business Park Drive Suite B Columbus, OH 432047/13/2018 11:59 AM
DetailsLast Recertification DateUpdateRecertification8/22/2016 12:00:00 AM11/16/2017 11:02:48 AM11/16/2017 11:02 AM
ContactsPrimary ContactUpdateProfile Change RequestSmith-Jenkins, Cescilly Regional Director, 340B Pharmacy Ascesnion WI 4148746268Smith-Jenkins, Cescilly Regional Director, 340B Pharmacy Ascension WI 414874626810/10/2017 2:09 PM
ContactsAuthorizing OfficialUpdate Freitag, Vanessa Vice President, Ambulatory Services and Operational Integration 4144653711Freitag, Vanessa Vice President, Ambulatory Services and Operational Integration Ascension 414465371110/5/2017 2:03 PM
ContactsPrimary ContactUpdate Smith-Jenkins, Cescilly Regional Director, 340B Pharmacy 4148746268Smith-Jenkins, Cescilly Regional Director, 340B Pharmacy Ascesnion WI 41487462689/18/2017 5:55 PM
ContactsAuthorizing OfficialInsert  Freitag, Vanessa Vice President, Ambulatory Services and Operational Integration 41446537118/13/2017 7:38 PM
ContactsPrimary ContactUpdate Hsu, Philip Director of Pharmacy 4142911069Smith-Jenkins, Cescilly Regional Director, 340B Pharmacy 41487462688/13/2017 7:38 PM
AddressesMain AddressInsert   2323 N LAKE DRIVE MILWAUKEE, WI 53211-45088/7/2017 7:34 AM
AddressesShipping AddressInsert  COLUMBIA ST MARY'S SETON PHARMACY 2323 N LAKE DRIVE MILWAUKEE, WI 532118/7/2017 7:34 AM
DetailsLast Recertification DateUpdate 9/8/2015 12:00:00 AM8/22/2016 12:00:00 AM8/22/2016 2:24 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/8/2015 3:52 PM
DetailsLast Recertification DateUpdate 9/10/2014 12:00:00 AM9/8/2015 12:00:00 AM9/8/2015 3:52 PM
DetailsEntity NameUpdate ST MARYS HOSPITAL OF MILWAUKEECOLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC12/10/2014 9:27 AM
DetailsEntity SubnameUpdate DBA COLUMBIA-ST MARYS-MILWAUKEE CAMPUSCOLUMBIA ST MARYS HOSPITAL MILWAUKEE12/10/2014 9:27 AM
DetailsLast Recertification DateUpdate 9/12/2013 12:00:00 AM9/10/2014 12:00:00 AM9/10/2014 4:03 PM
ContactsPrimary ContactInsert  Hsu, Philip Director of Pharmacy 41429110697/3/2014 4:20 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/12/2013 12:00:00 AM9/12/2013 8:11 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/17/2012 8:48 AM
Medicaid BillingMedicaid: NumberUpdate 52-0051110103004/5/2012 12:30 PM
Medicaid BillingNPI: NumberInsert  18716560824/5/2012 12:30 PM
DetailsComments PublicInsert  04/05/2012 medicaid # change added npi(was 52-0051); 4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE4/5/2012 12:30 PM
DetailsLast Recertification DateInsert   11/25/2008 8:49 AM
DetailsGrant NumberInsert   11/25/2008 8:49 AM
Details340B IDInsert  DSH52005111/25/2008 8:49 AM
DetailsIs Authorizing Official EHB DataInsert   11/25/2008 8:49 AM
DatesLast Date That 340B Drugs PurchasedInsert   11/25/2008 8:49 AM
DetailsMedicare Provider NumberInsert  52005111/25/2008 8:49 AM
DetailsEntity NameInsert  ST MARYS HOSPITAL OF MILWAUKEE11/25/2008 8:49 AM
DetailsProgram CodeInsert  DSH11/25/2008 8:49 AM
DetailsEntity SubnameInsert  DBA COLUMBIA-ST MARYS-MILWAUKEE CAMPUS11/25/2008 8:49 AM
DatesParticipating Approval DateInsert  4/24/2006 12:00:00 AM11/25/2008 8:49 AM
DetailsStateInsert  Active11/25/2008 8:49 AM
DatesRegistration DateInsert  4/24/2006 12:00:00 AM11/25/2008 8:49 AM
DatesSigned By DateInsert   11/25/2008 8:49 AM
DatesStart DateInsert  4/1/2004 12:00:00 AM11/25/2008 8:49 AM
TerminationsTermination CommentsInsert   11/25/2008 8:49 AM
TerminationsTermination DateInsert   11/25/2008 8:49 AM
TerminationsTermination Effective DateInsert   11/25/2008 8:49 AM
TerminationsTermination ReasonInsert   11/25/2008 8:49 AM
DetailsComments PublicInsert  4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE11/25/2008 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsert  True4/24/2006 7:49 AM
Medicaid BillingMedicaid: NumberInsert  52-00514/24/2006 7:49 AM
Medicaid BillingMedicaid: StateInsert  WI4/24/2006 7:49 AM