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DSH520136L WHEATON FRANCISCAN, INC. (Terminated)
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Main Details
Name
WHEATON FRANCISCAN, INC.
Subdivision Name
Wisconsin Heart Hospital & Midwest Spine & Orthopedic Hospital REHAB SVC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136L
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/6/2013
Last Recertification Date
8/24/2016
Termination Date
Termination Reason
10/1/2016
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
10000 WEST BLUEMOUND ROAD
WAUWATOSA, WI 53226-4321
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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