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DSH520051T COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
CSM Cardiovascular Specialists - Mequon - Radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051T
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
9/8/2015
Termination Date
Termination Reason
4/1/2016
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
13133 N. Port Washington Rd.
Suite 116
Mequon, WI 53097
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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