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DSH520136CA Ascension SE Wisconsin Hospital, Inc. (Active)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
OPERATING ROOM / Surgery Service
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136CA
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ascension Elmbrook Memorial Hospital
Kurt Ronald Schley, President
(262) 785-2239
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
201 N MAYFAIR RD
WAUWATOSA, WI 53226-4216
Billing Address
Ascension SE Wisconsin Hospital - St. Joseph Campus
5000 WEST CHAMBERS STREET
Milwaukee, WI 53210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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