340B Drug Pricing Program Database
LAKEVIEW PHARMACY OF RACINE INC
DSH520096 Ascension All Saints Hospital, Inc. - information as of 5/6/2025 11:28:03 PM
Covered Entity Details
Entity Name
Ascension All Saints Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520096
Entity Address
3801 SPRING STREET
RACINE, WI 53405
Medicare Provider Number
520096
Participating Start Date
4/1/2004
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
LAKEVIEW PHARMACY OF RACINE INC
Pharmacy Address
LAKEVIEW PHARMACY OF RACINE
516 MONUMENT SQ
RACINE, WI 53403-1033
Pharmacy Comments
Contract Details
Approval Date
2/15/2012
Contract Begin Date
2/15/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jon Sohn, CFO
(414) 465-3090
Contract Pharmacy Representative
Peter Ciaramita, President
(262) 632-0520
Signed By Date
1/12/2012
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