Details | Last Recertification Date | Update | Recertification | 8/23/2023 1:46:22 PM | 8/22/2024 3:15:40 PM | 8/22/2024 3:15 PM |
Contacts | Authorizing Official | Update | Change Request | Freitag, Vanessa
Vice President, Pharmacy
Ascension
7158971183 | Matuszewski, Jonathon
Hospital President
Ascension Wisconsin Franklin & St. Francis Hospitals
4146475106 | 4/16/2024 12:10 PM |
Contacts | Primary Contact | Update | Profile Change Request | Smith-Jenkins, Cescilly
340B Program Director – Wisconsin
Ascension WI
4144996174 | Smith-Jenkins, Cescilly
340B Program Director – Wisconsin
Ascension WI
4145227533 | 11/28/2023 2:37 PM |
Details | Last Recertification Date | Update | Recertification | 9/12/2022 3:43:16 PM | 8/23/2023 1:46:22 PM | 8/23/2023 1:46 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1073079455 (IA) | | 12/7/2022 3:47 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1073079455 (IL) | | 12/7/2022 3:47 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1073079455 (MI) | | 12/7/2022 3:47 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1073079455 (MN) | | 12/7/2022 3:47 PM |
Details | Last Recertification Date | Update | Recertification | 9/8/2021 1:31:28 PM | 9/12/2022 3:43:16 PM | 9/12/2022 3:43 PM |
Details | Last Recertification Date | Update | Recertification | 9/10/2020 8:29:27 AM | 9/8/2021 1:31:28 PM | 9/8/2021 1:31 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1073079455 | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | WI | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1073079455 | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | IA | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1073079455 | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | IL | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1073079455 | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | MI | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1073079455 | 6/11/2021 4:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | MN | 6/11/2021 4:57 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Freitag, Vanessa
Vice President, Ambulatory Services and Operational Integration
Ascension
4144653711 | Freitag, Vanessa
Vice President, Pharmacy
Ascension
7158971183 | 1/14/2021 3:35 PM |
Contacts | Primary Contact | Update | Profile Change Request | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
Ascension WI
4148746268 | Smith-Jenkins, Cescilly
340B Program Director – Wisconsin
Ascension WI
4144996174 | 10/15/2020 7:25 PM |
Details | Last Recertification Date | Update | Recertification | 9/12/2019 2:14:21 PM | 9/10/2020 8:29:27 AM | 9/10/2020 8:29 AM |
Details | Last Recertification Date | Update | Recertification | 8/20/2018 11:43:50 AM | 9/12/2019 2:14:21 PM | 9/12/2019 2:14 PM |
Details | Entity Name | Update | Change Request | WHEATON FRANCISCAN HEALTHCARE - ST FRANCIS | Ascension St. Francis Hospital, Inc. | 4/12/2019 4:46 PM |
Details | Last Recertification Date | Update | Recertification | 11/27/2017 5:14:02 PM | 8/20/2018 11:43:50 AM | 8/20/2018 11:43 AM |
Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/27/2017 5:14:02 PM | 11/27/2017 5:14 PM |
Details | Entity Name | Update | Recertification | ST. FRANCIS HOSPITAL | WHEATON FRANCISCAN HEALTHCARE - ST FRANCIS | 11/16/2017 11:08 AM |
Contacts | Primary Contact | Update | Profile Change Request | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
Ascesnion WI
4148746268 | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
Ascension WI
4148746268 | 10/10/2017 2:09 PM |
Contacts | Authorizing Official | Update | | Freitag, Vanessa
Vice President, Ambulatory Services and Operational Integration
4144653711 | Freitag, Vanessa
Vice President, Ambulatory Services and Operational Integration
Ascension
4144653711 | 10/5/2017 2:03 PM |
Contacts | Primary Contact | Update | | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
4148746268 | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
Ascesnion WI
4148746268 | 9/18/2017 5:55 PM |
Contacts | Authorizing Official | Update | | Baughman, Sharon
Senior Vice President /Chief Nursing Officer
4144472719 | Freitag, Vanessa
Vice President, Ambulatory Services and Operational Integration
4144653711 | 8/13/2017 7:38 PM |
Contacts | Primary Contact | Update | | Olley, Phillip
Pharmacy Manager
4146477163 | Smith-Jenkins, Cescilly
Regional Director, 340B Pharmacy
4148746268 | 8/13/2017 7:38 PM |
Contacts | Signed By | Insert | | | Gresham, James
Senior Vice President
4148746277 | 7/6/2017 1:16 PM |
Addresses | Main Address | Insert | | |
7410 WEST RAWSON AVENUE
ST FRANCIS REIMAN CENTER FOR CANCER CARE
FRANKLIN, WI 53132-8274 | 6/27/2017 8:02 AM |
Contacts | Authorizing Official | Insert | | | Baughman, Sharon
Senior Vice President /Chief Nursing Officer
4144472719 | 5/26/2017 8:02 AM |
Contacts | Primary Contact | Update | | Sabol, Kyle
Pharmacist
4146475043 | Olley, Phillip
Pharmacy Manager
4146477163 | 2/9/2017 12:47 PM |
Contacts | Primary Contact | Insert | | | Sabol, Kyle
Pharmacist
4146475043 | 10/3/2016 8:49 PM |
Details | Last Recertification Date | Update | | | 8/23/2016 12:00:00 AM | 8/23/2016 4:13 PM |
Dates | Participating Approval Date | Update | | | 11/9/2015 12:00:00 AM | 11/9/2015 3:08 PM |
Details | State | Update | | Pending | Active | 11/9/2015 3:08 PM |
Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 11/9/2015 3:08 PM |
Details | 340B ID | Update | | DEL_11052015_55506 | DSH520078E | 11/5/2015 11:30 AM |
Details | State | Update | | Rejected | Pending | 11/5/2015 11:30 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_55506 | DEL_11052015_55506 | 11/5/2015 10:44 AM |
Details | State | Update | | Pending | Rejected | 11/5/2015 10:44 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_55506 | 10/13/2015 6:48 PM |
Details | Last Recertification Date | Insert | | | | 10/13/2015 6:48 PM |
Details | Grant Number | Insert | | | | 10/13/2015 6:48 PM |
Details | 340B ID | Insert | | | | 10/13/2015 6:48 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 10/13/2015 6:48 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/13/2015 6:48 PM |
Details | Medicare Provider Number | Insert | | | 520078 | 10/13/2015 6:48 PM |
Details | Entity Name | Insert | | | ST. FRANCIS HOSPITAL | 10/13/2015 6:48 PM |
Details | Program Code | Insert | | | DSH | 10/13/2015 6:48 PM |
Details | Entity Subname | Insert | | | WHEATON FRANCISCAN HEALTHCARE / St Francis-MEDICAL ONCOLOGY-Reiman | 10/13/2015 6:48 PM |
Dates | Participating Approval Date | Insert | | | | 10/13/2015 6:48 PM |
Details | State | Insert | | | Pending | 10/13/2015 6:48 PM |
Dates | Registration Date | Insert | | | 10/13/2015 12:00:00 AM | 10/13/2015 6:48 PM |
Dates | Signed By Date | Insert | | | 10/13/2015 12:00:00 AM | 10/13/2015 6:48 PM |
Dates | Start Date | Insert | | | | 10/13/2015 6:48 PM |
Terminations | Termination Comments | Insert | | | | 10/13/2015 6:48 PM |
Terminations | Termination Date | Insert | | | | 10/13/2015 6:48 PM |
Terminations | Termination Effective Date | Insert | | | | 10/13/2015 6:48 PM |
Terminations | Termination Reason | Insert | | | | 10/13/2015 6:48 PM |