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DSH520051K COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Cardiac Rhythm Specialists - Milwaukee
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051K
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/1/2023
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
2350 N. Lake Drive
Suite 206
Milwaukee, WI 53211
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N. Lake Drive
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2013) until terminated effective date: (04/01/2018), reinstatement effective date: (04/1/2023)
01/31/2023
April 2025
April 2025
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