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DSH520075A ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS (Terminated)
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Main Details
Name
ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Subdivision Name
ST VINCENT HOSPITAL RENAL DIALYSIS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520075A
Medicare Provider Number
520075
Outpatient Facility Provider Number
522312
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/11/2014
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
HSHS
Patty Allen, Chief Financial Officer
(920) 884-5660
Primary Contact
HSHS St. Vincent Hospital
Susan Wheeler, PHARMACY DIRECTOR
(920) 459-4687
Addresses
Street Address
1920 S Libal St
Green Bay, WI 54301
Billing Address
Consolidated Services
PO Box 3646
Springfield, IL 62708
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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