340B Drug Pricing Program Database
SKYWALK PHARMACY WEST ALLIS
PED523300-00 CHILDREN'S HOSPITAL OF WISCONSIN, INC. - information as of 6/1/2025 4:58:40 AM
Covered Entity Details
Entity Name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Subdivision Name
Type
Children's Hospital
340B ID
PED523300-00
Entity Address
9000 W. WISCONSIN AVENUE
MILWAUKEE, WI 53226
Medicare Provider Number
523300
Participating Start Date
4/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
SKYWALK PHARMACY WEST ALLIS
Pharmacy Address
WEST ALLIS PRESCRIPTION CTR
6737 W WASHINGTON ST STE 1100
WEST ALLIS, WI 53214-5653
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Marc H. Gorelick, EXECUTIVE VICE PRESIDENT
(414) 266-2648
Contract Pharmacy Representative
Sklywalk
Kara Boghossian, Pharmacy Operations Manager
(414) 337-3341
Signed By Date
10/13/2016
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