Covered Entity Details

DSH520075A ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS (Terminated) - information as of 6/3/2025 12:03:38 PM

Main Details

Name

ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Subdivision Name

ST VINCENT HOSPITAL RENAL DIALYSIS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH520075A

Medicare Provider Number

520075

Outpatient Facility Provider Number

522312

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2014

Participating Start Date

4/1/2014

Participating Approval Date

3/11/2014

Last Recertification Date

9/13/2021

Termination Date
Termination Reason

4/1/2022
Business decision by the Covered Entity

Contacts

Authorizing Official

HSHS
Patty Allen, Chief Financial Officer
(920) 884-5660

Primary Contact

HSHS St. Vincent Hospital
Susan Wheeler, PHARMACY DIRECTOR
(920) 459-4687

Addresses

Street Address

1920 S Libal St
Green Bay, WI 54301

Billing Address

Consolidated Services
PO Box 3646
Springfield, IL 62708

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	42064500	1629051990

Shipping Addresses

Shipping Address 1

St. Vincent Hospital of the Hospital Sisters of the Third Order of St. Francis
835 S. Van Buren Street
Green Bay, WI 54301

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
DSH520075A	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	ST VINCENT HOSPITAL RENAL DIALYSIS	1920 S Libal St	Green Bay	WI	Terminated
DSH520075B	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	St. Vincent Hospital Sleep Lab	1821 S Webster Ave	GREEN BAY	WI	Terminated
DSH520075C	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	St. Vincent Hospital Outpatient Imaging Services	2502 S Ashland Ave	Green Bay	WI	Terminated
DSH520075D	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	St. Vincent Hospital Outpatient Imaging Services	1821 S Webster Ave	Green Bay	WI	Terminated
DSH520075E	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	St. Vincent Hospital Sleep Lab	1821 S Webster Ave	GREEN BAY	WI	Terminated
DSH520075F	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	HSHS St. Vincent Cancer Center at HSHS St. Clare Memorial Hospital	853 South Main Street	OCONTO FALLS	WI	Active
DSH520075G	Child	DSH	ST. VINCENT HOSPITAL	MARINETTE / MEDICAL ONCOLOGY	1409 CLEVELAND AVE	MARINETTE	WI	Terminated
DSH520075H	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	HSHS St. Vincent Cancer Center at HSHS St. Mary's Medical Center	1726 SHAWANO AVENUE	GREEN BAY	WI	Active
DSH520075J	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	HSHS St. Vincent Cancer Center at Door County Cancer Center	323 S 18TH AVE	STURGEON BAY	WI	Active
DSH520075K	Child	DSH	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	HSHS St. Vincent Cancer Centers at HSHS St. Nicholas Hospital - Medical Oncology	1621 N Taylor Dr	Sheboygan	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Allen, Patty Chief Financial Officer HSHS Wisconsin 9208845660	Allen, Patty Chief Financial Officer HSHS 9208845660	8/8/2024 6:32 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/13/2022 12:00:00 AM	1/20/2022 8:23 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/20/2022 8:23 AM
Terminations	Termination Comments	Update	Termination Request		business sold	1/20/2022 8:23 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	1/20/2022 8:23 AM
Terminations	Termination Effective Date	Update	Termination Request		1/14/2022 12:00:00 AM	1/20/2022 8:23 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	1/20/2022 8:23 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 9:16:10 AM	9/13/2021 11:33:15 AM	9/13/2021 11:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1629051990 ( )		9/2/2020 9:16 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1629051990	9/2/2020 9:16 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/2/2020 9:16 AM
Details	Last Recertification Date	Update	Recertification	9/13/2019 10:11:03 AM	9/2/2020 9:16:10 AM	9/2/2020 9:16 AM
Contacts	Authorizing Official	Update	Change Request	Pandl, Therese B President & CEO-Div, HSHS OPS/Wisc Region HSHS Eastern Wisconsin 9208845800	Allen, Patty Chief Financial Officer HSHS Wisconsin 9208845660	4/23/2020 7:11 AM
Addresses	Billing Address	Insert	Recertification		Consolidated Services PO Box 3646 Springfield, IL 62708	9/13/2019 10:11 AM
Addresses	Shipping Address	Insert	Recertification		St. Vincent Hospital of the Hospital Sisters of the Third Order of St. Francis 835 S. Van Buren Street Green Bay, WI 54301	9/13/2019 10:11 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 2:06:10 PM	9/13/2019 10:11:03 AM	9/13/2019 10:11 AM
Contacts	Authorizing Official	Update	AO Change Request	Simia, Greg A Chief Financial Officer Hospital Sisters Health System Eastern Wisconsin Division 9204984658	Pandl, Therese B President & CEO-Div, HSHS OPS/Wisc Region HSHS Eastern Wisconsin 9208845800	9/10/2019 2:13 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 12:30:44 PM	9/5/2018 2:06:10 PM	9/5/2018 2:06 PM
Contacts	Authorizing Official	Update	AO Change Request	Horvath, Joanne Vice President - Finance St. Vincent Hospital 9204313211	Simia, Greg A Chief Financial Officer Hospital Sisters Health System Eastern Wisconsin Division 9204984658	8/23/2018 6:38 AM
Details	Last Recertification Date	Update	Recertification	10/25/2017 2:18:28 PM	11/9/2017 12:30:44 PM	11/9/2017 12:30 PM
Details	Entity Name	Update	Recertification	ST.VINCENT HOSPITAL- HOSPITAL SISTERS-THIRD ORDER OF ST. FRANCIS	ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS	11/9/2017 12:21 PM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	10/25/2017 2:18:28 PM	10/25/2017 2:18 PM
Contacts	Primary Contact	Update		Wheeler, Susan PHARMACY DIRECTOR 9204594687	Wheeler, Susan PHARMACY DIRECTOR HSHS St. Vincent Hospital 9204594687	10/10/2017 5:37 PM
Contacts	Authorizing Official	Update		Horvath, Joanne Vice President - Finance 9204313211	Horvath, Joanne Vice President - Finance St. Vincent Hospital 9204313211	10/10/2017 9:43 AM
Contacts	Authorizing Official	Insert			Horvath, Joanne Vice President - Finance 9204313211	1/16/2017 11:30 AM
Contacts	Primary Contact	Insert			Wheeler, Susan PHARMACY DIRECTOR 9204594687	1/3/2017 7:41 AM
Addresses	Main Address	Insert			1920 S Libal St Green Bay, WI 54301	8/17/2016 2:16 PM
Contacts	Signed By	Insert			GIGOT, KELLY Vice President - Finance 9204338203	8/17/2016 2:16 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/17/2016 2:16 PM
Details	Last Recertification Date	Update		8/14/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 9:44 AM
Details	Last Recertification Date	Update			8/14/2014 12:00:00 AM	8/14/2014 2:47 PM
Dates	Participating Approval Date	Update			3/11/2014 12:00:00 AM	3/11/2014 11:41 PM
Details	State	Update		Pending	Active	3/11/2014 11:41 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	3/11/2014 11:41 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH520075A	2/19/2014 6:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2014 4:17 PM
Medicaid Billing	Medicaid: Number	Insert			42064500	1/15/2014 4:17 PM
Medicaid Billing	Medicaid: State	Insert			WI	1/15/2014 4:17 PM
Medicaid Billing	NPI: Number	Insert			1629051990	1/15/2014 4:17 PM
Details	Last Recertification Date	Insert				1/15/2014 4:17 PM
Details	Grant Number	Insert				1/15/2014 4:17 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/15/2014 4:17 PM
Details	Is Authorizing Official EHB Data	Insert				1/15/2014 4:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2014 4:17 PM
Details	Medicare Provider Number	Insert			520075	1/15/2014 4:17 PM
Details	Entity Name	Insert			ST.VINCENT HOSPITAL- HOSPITAL SISTERS-THIRD ORDER OF ST. FRANCIS	1/15/2014 4:17 PM
Details	Program Code	Insert			DSH	1/15/2014 4:17 PM
Details	Entity Subname	Insert			ST VINCENT HOSPITAL RENAL DIALYSIS	1/15/2014 4:17 PM
Dates	Participating Approval Date	Insert				1/15/2014 4:17 PM
Details	State	Insert			Pending	1/15/2014 4:17 PM
Dates	Registration Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:17 PM
Dates	Signed By Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:17 PM
Dates	Start Date	Insert				1/15/2014 4:17 PM
Terminations	Termination Comments	Insert				1/15/2014 4:17 PM
Terminations	Termination Date	Insert				1/15/2014 4:17 PM
Terminations	Termination Effective Date	Insert				1/15/2014 4:17 PM
Terminations	Termination Reason	Insert				1/15/2014 4:17 PM