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DSH520136AU WHEATON FRANCISCAN, INC. (Terminated)
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Main Details
Name
WHEATON FRANCISCAN, INC.
Subdivision Name
Elmbrook Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136AU
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/9/2013
Last Recertification Date
9/2/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
Kenneth Shaw, Reimbursement Manager
(414) 465-3545
Addresses
Street Address
19333 WEST NORTH AVENUE
Elmbrook, WI 53045-4132
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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