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DSH520096M WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS (Terminated)
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Main Details
Name
WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520096M
Medicare Provider Number
520096
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/29/2007
Participating Start Date
4/1/2007
Participating Approval Date
1/29/2000
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
1244 WISCONSIN AVENUE
RACINE, WI 53403
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/24/09 REMOVED SUBDIV NAME, ADDED SHIPPING ADDR; 5/30/08-REQUEST BY ENTITY TO REMOVE MEDICAID #33020700
01/29/2007
May 2025
May 2025
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