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DSH520177K FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Active)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
Eye Institute
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177K
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Froedtert Memorial Lutheran Hospital
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Primary Contact
Froedtert Memorial Lutheran Hospital
Casey Drake Spitzer, 340B Manager
(920) 319-6030
Addresses
Street Address
925 N. 87th Street
Milwaukee, WI 53226
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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