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DSH520136BN Ascension SE Wisconsin Hospital, Inc. (Active)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
Wauwatosa Cardiac Pulmonary Rehabilitation
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136BN
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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