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DSH520136B WHEATON FRANCISCAN, INC. (Terminated)
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Main Details
Name
WHEATON FRANCISCAN, INC.
Subdivision Name
WAUWATOSA CAMPUS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136B
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/20/2009
Participating Start Date
11/20/2009
Participating Approval Date
11/20/2009
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
4/1/2018
Other
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
201 N MAYFAIR ROAD
WAUWATOSA, WI 53226
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/10/09 UPDATED ENTITY NAME (WAS WHEATON FRANCISCAN HEALTHCARE-ST JOSEPH)
11/20/2009
April 2025
April 2025
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