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DSH520051C COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Airport Medical Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051C
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/25/2013
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
4/1/2024
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
4848 S. 6th Street
Milwaukee, WI 53221
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N Lake Dr
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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