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DSH520078B WHEATON FRANCISCAN HEALTHCARE - ST FRANCIS (Terminated)
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Main Details
Name
WHEATON FRANCISCAN HEALTHCARE - ST FRANCIS
Subdivision Name
ST FRANCIS SPORTS PERFORMANCE CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520078B
Medicare Provider Number
520078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/29/2010
Participating Start Date
2/1/2010
Participating Approval Date
2/1/2010
Last Recertification Date
8/23/2016
Termination Date
Termination Reason
1/1/2018
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
2025 W. OKLAHOMA AVE
MILWAUKEE, WI 53215
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/4/10 SHIP TO ADDED
03/30/2010
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