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DSH520051 COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051
Medicare Provider Number
520051
Additional Details
Current Program Status
Active
Registration Date
4/24/2006
Participating Start Date
4/1/2004
Participating Approval Date
4/24/2006
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
2323 N LAKE DRIVE
MILWAUKEE, WI 53211-4508
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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04/05/2012 medicaid # change added npi(was 52-0051); 4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE
04/05/2012
4/24/06 - REPLACES DSH53211, 10/14/04 - EDIT ZIP CODE
11/25/2008
April 2025
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