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DSH520096H WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS (Terminated)
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Main Details
Name
WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS
Subdivision Name
COUNSELING CENTER - KENOSHA
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520096H
Medicare Provider Number
520096
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2006
Participating Start Date
4/1/2004
Participating Approval Date
8/31/2006
Last Recertification Date
9/4/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
David Boman, Director of Pharmacy
(262) 687-4145
Addresses
Street Address
10117 74TH STREET
KENOSHA, WI 53142
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/27/11 REMOVED MEDICAID # (WAS 42231100); 8/31/06 - NAME CHANGE (FORMERLY ALL SAINTS MEDICAL CENTER, INC., ALL SAINTS COUNSELING CENTER - KENOSHA)
08/31/2006
May 2025
May 2025
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