340B Drug Pricing Program Database
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DSH520136BA Ascension SE Wisconsin Hospital, Inc. (Terminated)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
Elmbrook Laboratory
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136BA
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
9/12/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
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
19333 WEST NORTH AVENUE
Brookfield, WI 53045-4132
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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