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DSH520051BR COLUMBIA ST MARYS HOSPITAL MILWAUKEE (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE
Subdivision Name
Prospect Medical Commons / Cadiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051BR
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/31/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
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
2311 N. Prospect Ave.
Milwaukee, WI 53211
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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