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DSH520051AW COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Prospect Medical Commons
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051AW
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/12/2013
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
1/1/2024
Other
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
2311 N. Prospect Ave.
Milwaukee, WI 53211
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N Lake Dr
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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