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DSH520009B Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus (Active)
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Main Details
Name
Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus
Subdivision Name
Behavioral Health Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520009B
Medicare Provider Number
520009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/18/2016
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Ascension Wisconsin
Michael Bergmann, President
(920) 831-8913
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
1531 S. Madison Street
Appleton, WI 54915
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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