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DSH520177H FROEDTERT MEM. LUTHERAN HOSPT. (Terminated)
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Main Details
Name
FROEDTERT MEM. LUTHERAN HOSPT.
Subdivision Name
Plastic Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177H
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/17/2015
Last Recertification Date
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Froedtert Memorial Lutheran Hospital
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Primary Contact
Froedtert Memorial Lutheran Hospital
Chad Johnson, 340B Program Manager
(262) 532-5160
Addresses
Street Address
8700 W. Watertown Plank Road
Milwaukee, WI 53226
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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