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DSH520051AA COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Glendale Clinic - Green Bay Road - Radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051AA
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/12/2013
Last Recertification Date
9/10/2019
Termination Date
Termination Reason
4/1/2020
Hospital Outpatient facility no longer eligible
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
9252 N. Green Bay Road
Second Floor
Brown Deer, WI 53209
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N Lake Dr
Milwaukee, WI 53211-4445
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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