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PED523300-05 CHILDRENS HOSPITAL OF WISCONSIN (Terminated)
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Main Details
Name
CHILDRENS HOSPITAL OF WISCONSIN
Subdivision Name
Children's Hospital of Wisconsin Clinics - Foxpoint / Outpatient hospital specialty service
Type
Children's Hospital
Rural
No
340B ID
PED523300-05
Medicare Provider Number
523300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/31/2015
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Children's Hospital of Wisconsin
Scott Turner, COO CHW and EVP CHHS
(414) 266-2648
Primary Contact
Children's Hospital of Wisconsin
Thomas Lausten, Director of Pharmacy Services
(414) 266-2234
Addresses
Street Address
7950 N Port Washington Road
Foxpoint, WI 53217
Billing Address
Children's Hospital of Wisconsin
9000 W Wisconsin Avenue
Milwaukee, WI 53226
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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