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DSH520177F FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Active)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
Froedtert & Medical College of Wisconsin Reproductive Medicine Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177F
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Froedtert Memorial Lutheran Hospital
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Primary Contact
Froedtert Memorial Lutheran Hospital
Casey Drake Spitzer, 340B Manager
(920) 319-6030
Addresses
Street Address
W129 N7055 Northfield Drive
Building B
Menomonee Falls, WI 53051
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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