Covered Entity Details

DSH520098CJ UNIVERSITY OF WI HOSPITALS & CLINICS (Active) - information as of 5/9/2025 12:20:07 AM

Main Details

Name

UNIVERSITY OF WI HOSPITALS & CLINICS

Subdivision Name

E TERRACE DRIVE MEDICAL CENTER - IMAGING - DIAGNOSTIC

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH520098CJ

Medicare Provider Number

520098

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/4/2022

Participating Start Date

7/1/2022

Participating Approval Date

5/10/2022

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

UW Health
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131

Primary Contact

UW Health
Dan Schenkat, Director of Pharmacy - Business Services and East Madison Hospital
(608) 203-4897

Addresses

Street Address

5249 E TERRACE DR
MADISON, WI 53718

Billing Address

UW Health – Accounts Payable
PO Box 5448
Madison, WI 53705

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

Shipping Address 1

UW Health Pharmacy Services
5249 East Terrace Drive
Madison, WI 53718

Shipping Address 2

UW Health Pharmacy Services
3185 Deming Way
Rm 148
Middleton, WI 53562

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
DSH520098A	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - SURG/OR - OPERATING ROOM	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098AA	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - GENERAL PEDIATRICS	451 JUNCTION RD	MADISON	WI	Active
DSH520098AB	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION - IMAGING - DIAGNOSTIC	2880 UNIVERSITY AVE	MADISON	WI	Terminated
DSH520098AC	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY STATION CLINIC - CLINICS - PEDIATRIC OPHTHALMOLOGY	2880 UNIVERSITY AVE	MADISON	WI	Active
DSH520098AD	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - IMAGING - DIAGNOSTIC	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098AE	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - IMAGING - ULTRASONOGRAPHY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098AF	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - ENDOCRINOLOGY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AG	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - IMAGING - DIAGNOSTIC	621 SCIENCE DR	MADISON	WI	Active
DSH520098AH	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLIN LABS - CORE	1675 Highland Ave	Madison	WI	Active
DSH520098AJ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION - CLINICS - GENERAL PEDIATRICS	2880 UNIVERSITY AVE	MADISON	WI	Terminated
DSH520098AK	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY STATION CLINIC - CLINICS - OPHTHALMOLOGY	2880 UNIVERSITY AVE	MADISON	WI	Active
DSH520098AL	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	KIDNEY CLINIC - CLINICS - NEPHROLOGY	3034 FISH HATCHERY RD	MADISON	WI	Active
DSH520098AM	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - IMAGING - DIAGNOSTIC	451 JUNCTION RD	MADISON	WI	Active
DSH520098AN	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - ECHO/VASCULAR LAB	451 JUNCTION RD	MADISON	WI	Active
DSH520098AP	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - RHEUMATOLOGY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AQ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - GENERAL INTERNAL MEDICINE	451 JUNCTION RD	MADISON	WI	Active
DSH520098AR	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - MOHS DERM SURGERY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AS	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - ALLERGY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AT	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - DERMATOLOGY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AU	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - OB/GYN GENERAL	451 JUNCTION RD	MADISON	WI	Active
DSH520098AV	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - OPHTHALMOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
DSH520098AW	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - VASCULAR SURGERY	451 JUNCTION RD	MADISON	WI	Active
DSH520098AX	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - IMAGING - BREAST IMAGING	5249 E TERRACE DR	MADISON	WI	Active
DSH520098AY	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - IMAGING - ULTRASONOGRAPHY	621 SCIENCE DR	MADISON	WI	Active
DSH520098AZ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - IMAGING - MRI	621 SCIENCE DR	MADISON	WI	Active
DSH520098B	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - SURG/OR - PRE/POST & PACU	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098BA	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - IMAGING - ULTRASONOGRAPHY	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BB	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - SPECIALTY PROGRAMS	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BC	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - OPHTHALMOLOGY	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BD	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - HYBRID LABORATORY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BE	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - PREVENTITIVE CARDIOLOGY	621 SCIENCE DR	MADISON	WI	Active
DSH520098BF	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - RESPIRATORY THERAPY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BG	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - ENDOCRINOLOGY	5249 E Terrace Dr	Madison	WI	Active
DSH520098BH	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - GENERAL PEDIATRICS	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BJ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - PEDS CARDIOLOGY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BK	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - GENERAL INTERNAL MEDICINE	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BL	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - ANESTHESIOLOGY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BM	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - DIAGNOSTIC	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BN	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	WAISMAN CLINIC - CLINICS - GENETIC COUNSELOR SERVICES	1500 Highland Ave	Madison	WI	Terminated
DSH520098BP	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - PET IMAGING	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BQ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - GASTROENTEROLOGY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098BR	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - IMAGING - CT	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098BS	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - RADIATION ONCOLOGY	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BT	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - ULTRASONOGRAPHY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BU	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - DERMATOLOGY	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BV	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - MOHS DERM SURGERY	5249 E TERRACE DR	MADISON	WI	Active
DSH520098BW	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - PSYCHIATRY	5249 E TERRACE DR	MADISON	WI	Terminated
DSH520098BX	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - GI/BRONCHOSCOPY PROCEDURES	750 UNIVERSITY ROW	MADISON	WI	Terminated
DSH520098BY	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - OPERATING ROOM	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098BZ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - REHAB THERAPY - ORTHOTICS	621 SCIENCE DR	MADISON	WI	Active
DSH520098C	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - IMAGING - DIAGNOSTIC	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098CA	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - SURG/OR - ANESTHESIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098CB	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - PEDS SPECIALTIES	5249 E TERRACE DR	MADISON	WI	Active
DSH520098CC	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - AUDIOLOGY	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CD	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - CLINICS - GERIATRICS	5249 E TERRACE DR	MADISON	WI	Active
DSH520098CE	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - CLINICS - ORTHOPEDICS	621 SCIENCE DR	MADISON	WI	Active
DSH520098CF	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - ENDOSCOPY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098CG	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - REHAB THERAPY - PEDIATRIC FITNESS CLINIC	621 SCIENCE DR	MADISON	WI	Active
DSH520098CH	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - SPEECH	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CJ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	E TERRACE DRIVE MEDICAL CENTER - IMAGING - DIAGNOSTIC	5249 E TERRACE DR	MADISON	WI	Active
DSH520098CK	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - MULTI-D - GI ONCOLOGY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098CL	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - SPEECH	750 UNIVERSITY ROW	MADISON	WI	Terminated
DSH520098CM	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY AVE REHABILITATION CLINIC - CLINICS - REHAB MEDICINE	6630 UNIVERSITY AVE	MIDDLETON	WI	Active
DSH520098CN	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - TRANSPLANT	1675 Highland Ave	Madison	WI	Terminated
DSH520098CP	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - SURG/OR - PRE/POST & PACU	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CQ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - IMAGING - MRI	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CR	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - CLINICS - PEDS SPECIALTIES	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CS	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - CLINICS - CARDIOLOGY	621 SCIENCE DR	MADISON	WI	Active
DSH520098CT	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	WIMR - Imaging - Radiology	1111 HIGHLAND AVE	MADISON	WI	Terminated
DSH520098CU	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - COLON RECTAL SURGERY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098CV	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	2275 DEMING WAY CLINIC - CLINICS - PEDS SPECIALTIES	2275 DEMING WAY	MIDDLETON	WI	Active
DSH520098CW	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - IMAGING - NURSING	750 University Row	Madison	WI	Active
DSH520098CX	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	AFCH - NURSING - DIAGNOSTIC & THERAPY CTR	1675 HIGHLAND AVE	MADISON	WI	Active
DSH520098CY	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	UNIVERSITY AVE REHABILITATION CLINIC - REHAB THERAPY - ORTHOPEDICS	6630 UNIVERSITY AVE	MIDDLETON	WI	Active
DSH520098CZ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - CLINICS - RHEUMATOLOGY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098D	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - IMAGING - ULTRASONOGRAPHY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098DA	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - IMAGING - ANGIOGRAPHY	4621 EASTPARK BLVD	Madison	WI	Active
DSH520098DB	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - IMAGING - DIAGNOSTIC	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DC	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - IMAGING - NURSING	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DD	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - IMAGING - NUCLEAR MEDICINE	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DE	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - IMAGING - CT	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DF	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - ECHO/VASCULAR LAB	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DG	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - ALLERGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DH	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - CARDIOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DJ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - DERMATOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DK	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - ENDOCRINOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DL	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - GASTROENTEROLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DM	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - GERIATRICS	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DN	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - GYNECOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DP	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - HEMATOLOGY, ONCOLOGY & BMT	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DQ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - INFECTIOUS DISEASES/IMMUNOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DR	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - MOHS DERM SURGERY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DS	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - NEPHROLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DT	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - NEUROLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DU	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - NEUROSURGERY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DV	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - BREAST CENTER	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DW	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - CHEMOTHERAPY SERVICES	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DX	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - ONCOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DY	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - OTOLARYNGOLOGY ENT	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098DZ	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - PAIN	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098E	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - IMAGING - NUCLEAR MEDICINE	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098EA	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - PODIATRY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EB	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - PULMONARY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EC	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - RADIATION ONCOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098ED	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - RHEUMATOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EE	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - UROLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EF	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - BURN AND WOUND	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EG	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - MULTI-D ONCOLOGY	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098EH	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EASTPARK MEDICAL CENTER UW HEALTH - CLINICS - GYN ONC	4621 EASTPARK BLVD	MADISON	WI	Active
DSH520098F	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - IMAGING - CT	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098G	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - IMAGING - MRI	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098H	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - PREVENTIVE CARDIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098J	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	SCIENCE DR MEDICAL CENTER - ECHO/VASCULAR LAB	621 SCIENCE DR	MADISON	WI	Active
DSH520098K	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - CLINICS - SPECIALTY PROGRAMS	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098L	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - RESPIRATORY THERAPY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098M	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - ECHO/VASCULAR LAB	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098N	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - REHAB THERAPY - ORTHOTICS PROSTHETICS	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098P	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - CLINICS - CARDIOLOGY	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098Q	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - CLINICS - ORTHOPEDICS	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098R	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	EAST MADISON HOSPITAL - EMERG MED - EMERGENCY MEDICINE	4602 EASTPARK BLVD	MADISON	WI	Active
DSH520098S	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	WAISMAN CLINIC - CLINICS - PEDS SPECIALTIES	1500 HIGHLAND AVE	MADISON	WI	Active
DSH520098T	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	1102 S PARK ST CLINIC - CLINICS - PAIN	1102 S PARK ST	MADISON	WI	Active
DSH520098U	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	WOMENS PELVIC WELLNESS CLINIC - CLINICS - GYNECOLOGY	202 S PARK ST	MADISON	WI	Active
DSH520098V	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	DIGESTIVE HEALTH CENTER - CLINICS - HEPATOLOGY	750 UNIVERSITY ROW	MADISON	WI	Active
DSH520098W	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLINICS - WOMEN'S HEALTH GIM	451 JUNCTION RD	MADISON	WI	Terminated
DSH520098X	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - CLIN LABS - DERMATOPATHOLOGY	451 JUNCTION RD	MADISON	WI	Terminated
DSH520098Y	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	JUNCTION RD MEDICAL CENTER - IMAGING - BREAST IMAGING	451 JUNCTION RD	MADISON	WI	Active
DSH520098Z	Child	DSH	UNIVERSITY OF WI HOSPITALS & CLINICS	U STATION - CLINICS - GENERAL INTERNAL MEDICINE	2880 UNIVERSITY AVE	MADISON	WI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Group Change Request	UW Health Pharmacy Services 3185 Deming Way Middleton, WI 53562		4/15/2025 10:05 AM
Addresses	Shipping Address	Insert	Group Change Request		UW Health Pharmacy Services 3185 Deming Way Rm 148 Middleton, WI 53562	4/15/2025 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/26/2023 3:35:59 PM	8/23/2024 8:36:55 AM	8/23/2024 8:36 AM
Contacts	Primary Contact	Update	Group Change Request	Ngo, Melissa Manager-340B Operations and Support UW Health 6086622315	Schenkat, Dan Director of Pharmacy - Business Services and East Madison Hospital UW Health 6082034897	8/9/2024 6:35 AM
Addresses	Shipping Address	Delete	Recertification	UW Health Pharmacy Services Building 3185 Deming Way Middleton, WI 53562		8/26/2023 3:35 PM
Addresses	Shipping Address	Delete	Recertification	UW Health East Clinic Pharmacy 5249 East Terrace Drive Madison, WI 53718		8/26/2023 3:35 PM
Addresses	Shipping Address	Insert	Recertification		UW Health Pharmacy Services 3185 Deming Way Middleton, WI 53562	8/26/2023 3:35 PM
Addresses	Shipping Address	Insert	Recertification		UW Health Pharmacy Services 5249 East Terrace Drive Madison, WI 53718	8/26/2023 3:35 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 3:53:23 PM	8/26/2023 3:35:59 PM	8/26/2023 3:35 PM
Contacts	Primary Contact	Update	Change Request	Temple, Jack D Senior Pharmacy Director UW Health 6088211622	Ngo, Melissa Manager-340B Operations and Support UW Health 6086622315	4/10/2023 9:59 AM
Details	Entity Subname	Update	Change Request	EAST CLINIC - IMAGING - DIAGNOSTIC	E TERRACE DRIVE MEDICAL CENTER - IMAGING - DIAGNOSTIC	1/10/2023 8:44 AM
Details	Last Recertification Date	Update	Recertification		8/29/2022 3:53:23 PM	8/29/2022 3:53 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Flannery, Robert W Senior VP/Chief Financial Officer UW Health 6082657131	5/10/2022 10:29 AM
Details	340B ID	Update	New Registration		DSH520098CJ	5/10/2022 10:29 AM
Details	Entity Subname	Update	New Registration	EAST CLINIC	EAST CLINIC - IMAGING - DIAGNOSTIC	5/10/2022 10:29 AM
Dates	Participating Approval Date	Update	New Registration		5/10/2022 10:29:04 AM	5/10/2022 10:29 AM
Details	State	Update	New Registration	Pending	Approved	5/10/2022 10:29 AM
Dates	Signed By Date	Update	New Registration		4/8/2022 9:17:03 AM	5/10/2022 10:29 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	5/10/2022 10:29 AM
Addresses	Main Address	Insert	New Registration		5249 E TERRACE DR MADISON, WI 53718	4/4/2022 5:04 PM
Addresses	Billing Address	Insert	New Registration		UW Health – Accounts Payable PO Box 5448 Madison, WI 53705	4/4/2022 5:04 PM
Addresses	Shipping Address	Insert	New Registration		UW Health Pharmacy Services Building 3185 Deming Way Middleton, WI 53562	4/4/2022 5:04 PM
Addresses	Shipping Address	Insert	New Registration		UW Health East Clinic Pharmacy 5249 East Terrace Drive Madison, WI 53718	4/4/2022 5:04 PM
Contacts	Authorizing Official	Insert	New Registration		Flannery, Robert W Senior VP/Chief Financial Officer UW Health 6082657131	4/4/2022 5:04 PM
Contacts	Primary Contact	Insert	New Registration		Temple, Jack D Senior Pharmacy Director UW Health 6088211622	4/4/2022 5:04 PM
Details	Assistance Received From Date	Insert	New Registration			4/4/2022 5:04 PM
Details	Assistance Received To Date	Insert	New Registration			4/4/2022 5:04 PM
Details	Last Recertification Date	Insert	New Registration			4/4/2022 5:04 PM
Details	Grant Number	Insert	New Registration			4/4/2022 5:04 PM
Details	340B ID	Insert	New Registration			4/4/2022 5:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2022 5:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2022 5:04 PM
Details	Medicare Provider Number	Insert	New Registration		520098	4/4/2022 5:04 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF WI HOSPITALS & CLINICS	4/4/2022 5:04 PM
Details	NOFO Number	Insert	New Registration			4/4/2022 5:04 PM
Details	Program Code	Insert	New Registration		DSH	4/4/2022 5:04 PM
Details	Entity Subname	Insert	New Registration		EAST CLINIC	4/4/2022 5:04 PM
Dates	Participating Approval Date	Insert	New Registration			4/4/2022 5:04 PM
Details	State	Insert	New Registration		Pending	4/4/2022 5:04 PM
Dates	Registration Date	Insert	New Registration		4/4/2022 5:04:37 PM	4/4/2022 5:04 PM
Dates	Signed By Date	Insert	New Registration			4/4/2022 5:04 PM
Dates	Start Date	Insert	New Registration			4/4/2022 5:04 PM
Terminations	Termination Comments	Insert	New Registration			4/4/2022 5:04 PM
Terminations	Termination Date	Insert	New Registration			4/4/2022 5:04 PM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2022 5:04 PM
Terminations	Termination Reason	Insert	New Registration			4/4/2022 5:04 PM