Covered Entity Details

SCH520019-03 Ascension Sacred Heart - St. Mary's Hospitals, Inc. (Terminated) - information as of 5/11/2025 11:34:21 PM

Main Details

Name

Ascension Sacred Heart - St. Mary's Hospitals, Inc.

Subdivision Name

Ministry Medical Group-Laona

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH520019-03

Medicare Provider Number

520019

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/13/2012

Participating Start Date

4/1/2012

Participating Approval Date

3/5/2012

Last Recertification Date

11/13/2017

Termination Date
Termination Reason

7/1/2018
Site closure

Contacts

Authorizing Official

Ascension Eagle River Hospital
Laurie Oungst, Chief Administrative Officer
(715) 356-8560

Primary Contact

Ascension WI
Bryan Pearce, 340B Program Director - North Region
(715) 479-0312

Addresses

Street Address

4876 Mill Street
Laona, WI 54541

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?
No

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
SCH520019-01	Child	SCH	Ascension Sacred Heart - St. Mary's Hospitals, Inc. DBA Ascension Saint Mary's Hospital	Ministry Medical Group-Crandon	400 West Glen St.	Crandon	WI	Terminated
SCH520019-02	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS EAGLE RIVER CLINIC	930 East Wall St.	Eagle River	WI	Terminated
SCH520019-03	Child	SCH	Ascension Sacred Heart - St. Mary's Hospitals, Inc.	Ministry Medical Group-Laona	4876 Mill Street	Laona	WI	Terminated
SCH520019-04	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS RHINELANDER CLINIC - N SHORE DRIVE	2251 North Shore Dr.	Rhinelander	WI	Terminated
SCH520019-05	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS KOLLER BEHAVIORAL HEALTH CLINIC	1020 Kabel Avenue	Rhinelander	WI	Terminated
SCH520019-07	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS CRANDON CLINIC - CRANDON FAMILY PRACTICE	400 W GLEN STREET	CRANDON	WI	Terminated
SCH520019-08	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS TOMAHAWK CLINIC - TOMAHAWK FAMILY PRACTICE	401 W MOHAWK DR	TOMAHAWK	WI	Terminated
SCH520019-09	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS WOODRUFF CLINIC - MAPLE STREET - ASPIRUS WOODRUFF CLINIC - MAPLE STREET	240 MAPLE STREET	WOODRUFF	WI	Terminated
SCH520019-10	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS IOLA CLINIC - IOLA FAMILY PRACTICE	205 S MAIN STREET	IOLA	WI	Terminated
SCH520019-11	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS Wittenberg Clinic - Wittenberg	1660 Sue Alan Drive	Wittenberg	WI	Terminated
SCH520019-12	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE	824 ILLINOIS VE	STEVENS POINT	WI	Terminated
SCH520019-13	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - HOOVER ROAD - STEVENS POINT FAMILY PRACTICE HOOVER ROAD	3500 HOOVER RD	STEVENS POINT	WI	Terminated
SCH520019-14	Child	SCH	ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC. - DBA ASPIRUS RHINELANDER HOSPITAL	ASPIRUS RHINELANDER CLINIC - N CHIPPEWA DRIVE - N CHIPPEWA DRIVE FAMILY PRACTICE	1630 N CHIPPEWA DRIVE	RHINELANDER	WI	Terminated
SCH520019-15	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS PLOVER CLINIC - PLOVER ROAD - PLOVER FAMILY PRACTICE - PLOVER ROAD	2401 PLOVER ROAD	PLOVER	WI	Terminated
SCH520019-16	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS AMHERST CLINIC - AMHERST FAMILY PRACTICE	272 CHRISTY STREET	AMHERST	WI	Terminated
SCH520019-17	Child	SCH	ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, INC. - DBA ASPIRUS RHINELANDER HOSPITAL	ASPIRUS PLOVER CLINIC - VERN HOLMES DRIVE - VERN HOLMES DRIVE - FAMILY PRACTICE	5409 VERN HOLMES DRIVE	STEVENS POINT	WI	Terminated
SCH520019-18	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS WOODRUFF CLINIC - MAPLE STR - OB	240 MAPLE ST	WOODRUFF	WI	Terminated
SCH520019-19	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS WOODRUFF CLINIC - MAPLE STR - PODIATRY	240 MAPLE ST	WOODRUFF	WI	Terminated
SCH520019-21	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS PLOVER CLINIC - PLOVER ROAD - WALK IN	2401 PLOVER RD	PLOVER	WI	Terminated
SCH520019-22	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - ALLERGY	824 ILLINOIS VE	STEVENS POINT	WI	Terminated
SCH520019-23	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - SURGERY - GENERAL SURGERY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-24	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - NEUROLOGY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-25	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - DERMATOLOGY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-26	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - DIABETIC	824 ILLINOIS VE	STEVENS POINT	WI	Terminated
SCH520019-27	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - ENT	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-28	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - UROLOGY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-29	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - OB	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-30	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - WOUND	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-31	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - GI	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-32	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - OPHTHAMOLOGY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated
SCH520019-33	Child	SCH	ASPIRUS RHINELANDER HOSPITAL	ASPIRUS STEVENS POINT CLINIC - ILLINOIS AVE - PODIATRY	824 ILLINOIS AVE	STEVENS POINT	WI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Reinstatement	Theiler, Teresa Chief Administrative Officer St Mary Admin Ministry Health Care 7153612177	Oungst, Laurie Chief Administrative Officer Ascension Eagle River Hospital 7153568560	4/10/2020 9:14 AM
Contacts	Authorizing Official	Update	Change Request	Anderson, Sandra Regional Vice President - Northern Region & Hospital President Ascension 7153612007	Theiler, Teresa Chief Administrative Officer St Mary Admin Ministry Health Care 7153612177	7/9/2019 7:50 AM
Details	State	Update		To Be Terminated	Terminated	7/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/27/2018 12:00:00 AM	6/1/2018 3:02 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/1/2018 3:02 PM
Terminations	Termination Date	Update	Termination Request		7/1/2018 12:00:00 AM	6/1/2018 3:02 PM
Terminations	Termination Effective Date	Update	Termination Request		4/30/2018 12:00:00 AM	6/1/2018 3:02 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	6/1/2018 3:02 PM
Details	Entity Name	Update	Change Request	Ministry Saint Mary's Hospital	Ascension Sacred Heart - St. Mary's Hospitals, Inc.	12/15/2017 8:55 AM
Contacts	Authorizing Official	Update	Change Request	Zenk, Ann Regional Vice President-Northern Region 7153612177	Anderson, Sandra Regional Vice President - Northern Region & Hospital President Ascension 7153612007	11/30/2017 11:35 AM
Contacts	Primary Contact	Update	Recertification	Jamison, Brad Pharmacy Manager 7153612650	Pearce, Bryan 340B Program Director - North Region Ascension WI 7154790312	11/13/2017 5:47 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/13/2017 5:47:13 PM	11/13/2017 5:47 PM
Contacts	Signed By	Insert			Erickson, Bill Vice President-Operations 7153612012	8/18/2016 2:51 PM
Addresses	Main Address	Insert			4876 Mill Street Laona, WI 54541	8/18/2016 2:51 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 2:51 PM
Contacts	Authorizing Official	Insert			Zenk, Ann Regional Vice President-Northern Region 7153612177	8/19/2015 11:10 AM
Details	Last Recertification Date	Update		8/11/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 10:43 AM
Contacts	Primary Contact	Insert			Jamison, Brad Pharmacy Manager 7153612650	9/8/2014 7:46 AM
Details	Last Recertification Date	Update		8/28/2013 2:51:51 PM	8/11/2014 12:00:00 AM	8/11/2014 9:29 AM
Details	Last Recertification Date	Update			8/28/2013 2:51:51 PM	8/28/2013 2:51 PM
Details	340B ID	Update		IS-CA-SCH520019-03	SCH520019-03	3/5/2012 3:19 PM
Dates	Participating Approval Date	Update			3/5/2012 12:00:00 AM	3/5/2012 3:19 PM
Details	State	Update		Pending	Active	3/5/2012 3:19 PM
Details	340B ID	Update		CA-SCH520019-03	IS-CA-SCH520019-03	2/13/2012 10:21 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CA-SCH520019-03	1/27/2012 3:32 PM
Dates	Start Date	Update			4/1/2012 12:00:00 AM	1/27/2012 3:32 PM
Details	Last Recertification Date	Insert				1/13/2012 9:16 AM
Details	Grant Number	Insert				1/13/2012 9:16 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/13/2012 9:16 AM
Details	Is Authorizing Official EHB Data	Insert				1/13/2012 9:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2012 9:16 AM
Details	Medicare Provider Number	Insert			520019	1/13/2012 9:16 AM
Details	Entity Name	Insert			Ministry Saint Mary's Hospital	1/13/2012 9:16 AM
Details	Program Code	Insert			SCH	1/13/2012 9:16 AM
Details	Entity Subname	Insert			Ministry Medical Group-Laona	1/13/2012 9:16 AM
Dates	Participating Approval Date	Insert				1/13/2012 9:16 AM
Details	State	Insert			Pending	1/13/2012 9:16 AM
Dates	Registration Date	Insert			1/13/2012 12:00:00 AM	1/13/2012 9:16 AM
Dates	Signed By Date	Insert			1/13/2012 12:00:00 AM	1/13/2012 9:16 AM
Dates	Start Date	Insert				1/13/2012 9:16 AM
Terminations	Termination Comments	Insert				1/13/2012 9:16 AM
Terminations	Termination Date	Insert				1/13/2012 9:16 AM
Terminations	Termination Effective Date	Insert				1/13/2012 9:16 AM
Terminations	Termination Reason	Insert				1/13/2012 9:16 AM