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DSH520051BH COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Riverwoods Urgent Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051BH
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/31/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
375 W. River Woods Pkwy
Glendale, WI 53212
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N Lake Dr
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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