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DSH520051AM COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Columbia West - Rehab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051AM
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
8/22/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
Laura Alar, Director of Pharmacy and Retail Medicine
(414) 585-1071
Addresses
Street Address
10950 W. Capitol Dr.
Wauwatosa, WI 53222
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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