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DSH520075E 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 Sleep Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520075E
Medicare Provider Number
520075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/9/2014
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
10/1/2019
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
1821 S Webster Ave
GREEN BAY, WI 54301-2253
Billing Address
ST.VINCENT HOSPITAL- HOSPITAL SISTERS-THIRD ORDER OF ST. FRANCIS
PO BOX 13508
GREEN BAY, WI 54307-3508
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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