Covered Entity Details

DSH520009P Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus (Active) - information as of 5/2/2025 10:32:36 PM

Main Details

Name

Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus

Subdivision Name

ASCENSION NE WISCONSIN-MERCY CAMPUS - Wound Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH520009P

Medicare Provider Number

520009

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2019

Participating Start Date

4/1/2019

Participating Approval Date

2/21/2019

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Ascension Wisconsin
Michael Bergmann, President
(920) 831-8913

Primary Contact

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

Addresses

Street Address

2700 W. 9th Ave
Suite 103
OSHKOSH, WI 54904

Billing Address

ASCENSION NE WISCONSIN-MERCY CAMPUS
500 S. Oakwood Rd
Oshkosh, WI 54904-7944

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		1912527193

Shipping Addresses

Shipping Address 1

ASCENSION NE WISCONSIN-MERCY CAMPUS
500 S. Oakwood Rd
Oshkosh, WI 54904-7944

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
DSH520009A	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	Midway Surgery Center	1550 Midway Place	Menasha	WI	Active
DSH520009AA	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	Koeller Urgent Care - Urgent Care	1855 S Koeller St	Oshkosh	WI	Approved
DSH520009AB	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	Richmond Urgent Care - Urgent Care	3329 N Richmond St	Appleton	WI	Approved
DSH520009B	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	Behavioral Health Clinic	1531 S. Madison Street	Appleton	WI	Active
DSH520009C	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - CANCER CENTER	2700 W 9TH AVE	OSHKOSH	WI	Active
DSH520009D	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Emergency	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009E	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - CT	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009F	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Cardiac Catheterization	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009G	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Breast Center	2700 W. 9th Ave	OSHKOSH	WI	Active
DSH520009H	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Operating Room	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009J	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - MRI	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009K	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Recovery	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009L	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Radiology	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009M	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Anesthesiology	500 S OAKWOOD RD	OSHKOSH	WI	Active
DSH520009N	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Outpatient Behavioral Health	2700 W 9th Ave	Oshkosh	WI	Active
DSH520009P	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Wound Clinic	2700 W. 9th Ave	OSHKOSH	WI	Active
DSH520009Q	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Radiation Oncology - Radiation Oncology	2700 W. 9th Ave	Oshkosh	WI	Active
DSH520009R	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Cardiac Rehabilitation - Cardiac Rehabilitation	2700 W. 9th Ave	Oshkosh	WI	Active
DSH520009S	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Diagnostic Cardiology - Diagnostic Cardiology	500 S. Oakwood Rd	Oshkosh	WI	Active
DSH520009T	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Outpatient Procedure Area - Perioperative Care	500 S. Oakwood Rd	Oshkosh	WI	Active
DSH520009U	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Pheresis - Pheresis	500 S. Oakwood Rd	Oshkosh	WI	Terminated
DSH520009V	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Respiratory Therapy - Respiratory Therapy	500 S. Oakwood Rd	Oshkosh	WI	Active
DSH520009W	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Cardiac Nuclear Medicine - Cardiac Nuclear Medicine	500 S. Oakwood Rd	Oshkosh	WI	Active
DSH520009X	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Cardiac Ultrasound - Cardiac Ultrasound	500 S. Oakwood Rd	Oshkosh	WI	Active
DSH520009Y	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	ASCENSION NE WISCONSIN-MERCY CAMPUS - Medical Oncology - Oncology	2700 W. 9th Ave	Oshkosh	WI	Active
DSH520009Z	Child	DSH	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	Neenah Urgent Care - Urgent Care	101 Main St	Neenah	WI	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 1:49:22 PM	8/19/2024 4:54:08 PM	8/19/2024 4:54 PM
Contacts	Authorizing Official	Update	AO Change Request	Freitag, Vanessa Vice President, Pharmacy Ascension 7158971183	Bergmann, Michael President Ascension Wisconsin 9208318913	4/2/2024 6:34 AM
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	9/13/2022 8:50:40 AM	8/23/2023 1:49:22 PM	8/23/2023 1:49 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1912527193	12/7/2022 3:27 PM
Medicaid Billing	NPI: State	Insert	Change Request		WI	12/7/2022 3:27 PM
Addresses	Main Address	Update	Recertification	2700 W. 9th Ave OSHKOSH, WI 54904	2700 W. 9th Ave Suite 103 OSHKOSH, WI 54904	9/13/2022 8:50 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 1:37:49 PM	9/13/2022 8:50:40 AM	9/13/2022 8:50 AM
Addresses	Main Address	Update	Change Request	500 S OAKWOOD RD OSHKOSH, WI 54904-7944	2700 W. 9th Ave OSHKOSH, WI 54904	10/14/2021 8:09 AM
Addresses	Billing Address	Insert	Change Request		ASCENSION NE WISCONSIN-MERCY CAMPUS 500 S. Oakwood Rd Oshkosh, WI 54904-7944	10/14/2021 8:09 AM
Addresses	Shipping Address	Insert	Change Request		ASCENSION NE WISCONSIN-MERCY CAMPUS 500 S. Oakwood Rd Oshkosh, WI 54904-7944	10/14/2021 8:09 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:58:22 AM	9/8/2021 1:37:49 PM	9/8/2021 1:37 PM
Details	Entity Name	Update	Change Request	St. Elizabeth Hospital	Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus	5/18/2021 3:18 PM
Contacts	Authorizing Official	Update	Change Request	Hilt, Monica Ann President St. Elizabeth Hospital 9208318913	Freitag, Vanessa Vice President, Pharmacy Ascension 7158971183	5/4/2021 9:49 AM
Contacts	Primary Contact	Update	Change Request	Pearce, Bryan 340B Program Director - North Region Ascension WI 7154790312	Smith-Jenkins, Cescilly 340B Program Director – Wisconsin Ascension WI 4144996174	4/28/2021 1:13 PM
Details	Last Recertification Date	Update	Recertification	8/30/2019 7:21:14 AM	8/17/2020 11:58:22 AM	8/17/2020 11:58 AM
Details	Last Recertification Date	Update	Recertification		8/30/2019 7:21:14 AM	8/30/2019 7:21 AM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Authorizing Official	Update	Change Request	Hilt, Monica Regional VP And Hospital President Ascension WI 9208318913	Hilt, Monica Ann President St. Elizabeth Hospital 9208318913	3/6/2019 8:12 AM
Contacts	Signed By	Insert	New Registration		Hilt, Monica Regional VP And Hospital President Ascension WI 9208318913	2/21/2019 9:48 AM
Details	340B ID	Update	New Registration		DSH520009P	2/21/2019 9:48 AM
Details	Entity Name	Update	New Registration	ST. ELIZABETH HOSPITAL	St. Elizabeth Hospital	2/21/2019 9:48 AM
Details	Entity Subname	Update	New Registration	ASCENSION NE WISCONSIN-MERCY CAMPUS	ASCENSION NE WISCONSIN-MERCY CAMPUS - Wound Clinic	2/21/2019 9:48 AM
Dates	Participating Approval Date	Update	New Registration		2/21/2019 9:48:37 AM	2/21/2019 9:48 AM
Details	State	Update	New Registration	Pending	Approved	2/21/2019 9:48 AM
Dates	Signed By Date	Update	New Registration		1/14/2019 5:45:11 PM	2/21/2019 9:48 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	2/21/2019 9:48 AM
Addresses	Main Address	Insert	New Registration		500 S OAKWOOD RD OSHKOSH, WI 54904-7944	1/12/2019 11:55 AM
Contacts	Authorizing Official	Insert	New Registration		Hilt, Monica Regional VP And Hospital President Ascension WI 9208318913	1/12/2019 11:55 AM
Contacts	Primary Contact	Insert	New Registration		Pearce, Bryan 340B Program Director - North Region Ascension WI 7154790312	1/12/2019 11:55 AM
Details	Last Recertification Date	Insert	New Registration			1/12/2019 11:55 AM
Details	Grant Number	Insert	New Registration			1/12/2019 11:55 AM
Details	340B ID	Insert	New Registration			1/12/2019 11:55 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2019 11:55 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2019 11:55 AM
Details	Medicare Provider Number	Insert	New Registration		520009	1/12/2019 11:55 AM
Details	Entity Name	Insert	New Registration		ST. ELIZABETH HOSPITAL	1/12/2019 11:55 AM
Details	Program Code	Insert	New Registration		DSH	1/12/2019 11:55 AM
Details	Entity Subname	Insert	New Registration		ASCENSION NE WISCONSIN-MERCY CAMPUS	1/12/2019 11:55 AM
Dates	Participating Approval Date	Insert	New Registration			1/12/2019 11:55 AM
Details	State	Insert	New Registration		Pending	1/12/2019 11:55 AM
Dates	Registration Date	Insert	New Registration		1/12/2019 11:55:40 AM	1/12/2019 11:55 AM
Dates	Signed By Date	Insert	New Registration			1/12/2019 11:55 AM
Dates	Start Date	Insert	New Registration			1/12/2019 11:55 AM
Terminations	Termination Comments	Insert	New Registration			1/12/2019 11:55 AM
Terminations	Termination Date	Insert	New Registration			1/12/2019 11:55 AM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2019 11:55 AM
Terminations	Termination Reason	Insert	New Registration			1/12/2019 11:55 AM