Covered Entity Details

RRC520198-10 AURORA MEDICAL CENTER OF OSHKOSH (Active) - information as of 4/26/2025 11:41:15 PM

Main Details

Name

AURORA MEDICAL CENTER OF OSHKOSH

Subdivision Name

PAIN MANAGAEMENT - Pain

Type

Rural Referral Center

Rural

Yes

340B ID

RRC520198-10

Medicare Provider Number

520198

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/7/2023

Participating Start Date

10/1/2023

Participating Approval Date

9/12/2023

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765

Primary Contact

Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457

Addresses

Street Address

700 N Westhaven Dr.
Oshkosh, WI 54904

Billing Address

Aurora Medical Center of Oshkosh
855 N. WESTHAVEN DRIVE
OSHKOSH, WI 54904

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	11024300	1275578064
IL	11024300	1275578064

Shipping Addresses

Shipping Address 1

Aurora Medical Center of Oshkosh
855 N. WESTHAVEN DRIVE
OSHKOSH, WI 54904

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
RRC520198-01	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AMCO Adult IOP - Intensive Outpatient Program	414 Doctors CT	Oshkosh	WI	Terminated
RRC520198-02	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AURORA PHYSICAL THERAPY - Physical Medicine Rehab	900 E DIVISION ST	WAUTOMA	WI	Terminated
RRC520198-03	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AURORA PHYSICAL THERAPY - Sleep Medicine	712 DOCTORS CT	OSHKOSH	WI	Active
RRC520198-04	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AURORA SPORTS HEALTH - Physical Medicine Rehab	1136 WESTOWNE DR	NEENAH	WI	Terminated
RRC520198-05	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	SURGERY CENTER OF AURORA MEDICAL CE - Radiology	210 WISCONSIN AMERICAN DR	FOND DU LAC	WI	Active
RRC520198-06	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	SURGERY CENTER OF AURORA MEDICAL CE - Anesthesia/Pain mgmt./ OR	210 WISCONSIN AMERICAN DR	FOND DU LAC	WI	Active
RRC520198-07	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AURORA PHYSICAL THERAPY - Physical Medicine Rehab	712 DOCTORS CT	OSHKOSH	WI	Terminated
RRC520198-08	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	SURGERY CENTER OF AURORA MEDICAL CE - Physical Medicine Rehab	210 WISCONSIN AMERICAN DR	FOND DU LAC	WI	Terminated
RRC520198-09	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	AURORA SPORTS HEALTH JACKSON STREET - Physical Medicine Rehab	135 JACKSON ST	OSHKOSH	WI	Terminated
RRC520198-10	Child	RRC	AURORA MEDICAL CENTER OF OSHKOSH	PAIN MANAGAEMENT - Pain	700 N Westhaven Dr.	Oshkosh	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Recertification		Aurora Medical Center of Oshkosh 855 N. WESTHAVEN DRIVE OSHKOSH, WI 54904	8/16/2024 1:50 PM
Details	Last Recertification Date	Update	Recertification		8/16/2024 1:50:01 PM	8/16/2024 1:50 PM
Contacts	Primary Contact	Update	Change Request	Nowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	Nowak, Jason G Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	7/22/2024 3:54 PM
Contacts	Authorizing Official	Update	Profile Change Request	Nelson, Nan SVP-Finance Advocate Aurora Health Care 4142991610	Nelson, Nan SVP-Finance Advocate Aurora Health Care 4143784765	2/7/2024 11:14 AM
Contacts	Signed By	Update	Profile Change Request	Nelson, Nan SVP-Finance Advocate Aurora Health Care 4142991610	Nelson, Nan SVP-Finance Advocate Aurora Health Care 4143784765	2/7/2024 11:14 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Nelson, Nan SVP-Finance Advocate Aurora Health Care 4142991610	9/12/2023 7:48 AM
Details	340B ID	Update	New Registration		RRC520198-10	9/12/2023 7:48 AM
Details	Entity Subname	Update	New Registration	PAIN MANAGAEMENT	PAIN MANAGAEMENT - Pain	9/12/2023 7:48 AM
Dates	Participating Approval Date	Update	New Registration		9/12/2023 7:48:59 AM	9/12/2023 7:48 AM
Details	State	Update	New Registration	Pending	Approved	9/12/2023 7:48 AM
Dates	Signed By Date	Update	New Registration		7/12/2023 11:44:55 AM	9/12/2023 7:48 AM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	9/12/2023 7:48 AM
Addresses	Main Address	Insert	New Registration		700 N Westhaven Dr. Oshkosh, WI 54904	7/7/2023 3:36 PM
Addresses	Billing Address	Insert	New Registration		Aurora Medical Center of Oshkosh 855 N. WESTHAVEN DRIVE OSHKOSH, WI 54904	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		11024300	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WI	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		11024300	7/7/2023 3:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	7/7/2023 3:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275578064	7/7/2023 3:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		WI	7/7/2023 3:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275578064	7/7/2023 3:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/7/2023 3:36 PM
Contacts	Authorizing Official	Insert	New Registration		Nelson, Nan SVP-Finance Advocate Aurora Health Care 4142991610	7/7/2023 3:36 PM
Contacts	Primary Contact	Insert	New Registration		Nowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 4146408457	7/7/2023 3:36 PM
Details	Assistance Received From Date	Insert	New Registration			7/7/2023 3:36 PM
Details	Assistance Received To Date	Insert	New Registration			7/7/2023 3:36 PM
Details	Last Recertification Date	Insert	New Registration			7/7/2023 3:36 PM
Details	Grant Number	Insert	New Registration			7/7/2023 3:36 PM
Details	340B ID	Insert	New Registration			7/7/2023 3:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/7/2023 3:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/7/2023 3:36 PM
Details	Medicare Provider Number	Insert	New Registration		520198	7/7/2023 3:36 PM
Details	Entity Name	Insert	New Registration		AURORA MEDICAL CENTER OF OSHKOSH	7/7/2023 3:36 PM
Details	NOFO Number	Insert	New Registration			7/7/2023 3:36 PM
Details	Program Code	Insert	New Registration		RRC	7/7/2023 3:36 PM
Details	Entity Subname	Insert	New Registration		PAIN MANAGAEMENT	7/7/2023 3:36 PM
Dates	Participating Approval Date	Insert	New Registration			7/7/2023 3:36 PM
Details	State	Insert	New Registration		Pending	7/7/2023 3:36 PM
Dates	Registration Date	Insert	New Registration		7/7/2023 3:36:20 PM	7/7/2023 3:36 PM
Dates	Signed By Date	Insert	New Registration			7/7/2023 3:36 PM
Dates	Start Date	Insert	New Registration			7/7/2023 3:36 PM
Terminations	Termination Comments	Insert	New Registration			7/7/2023 3:36 PM
Terminations	Termination Date	Insert	New Registration			7/7/2023 3:36 PM
Terminations	Termination Effective Date	Insert	New Registration			7/7/2023 3:36 PM
Terminations	Termination Reason	Insert	New Registration			7/7/2023 3:36 PM