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DSH520051S COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Cathedral Square Rehab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051S
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
10/1/2016
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
734 N. Jackson St.
Milwaukee, WI 53202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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