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CAH521317-00 Ascension Calumet Hospital, Inc. (Active)
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Main Details
Name
Ascension Calumet Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521317-00
Medicare Provider Number
521317
Additional Details
Current Program Status
Active
Registration Date
11/16/2010
Participating Start Date
1/1/2011
Participating Approval Date
11/16/2010
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Ascension Wisconsin
Michael Bergmann, President
(920) 831-8913
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
614 MEMORIAL DRIVE
CHILTON, WI 53014
Billing Address
St Eliz/Cal Med Ctr PHS
ATTN: Pharmacy Dept
1506 S Oneida St
Appleton, WI 54915
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/11/12- deleted medicaid #(was 11015300)
04/11/2012
May 2025
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