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DSH520051BV COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
COLUMBIA ST MARYS HOSPITAL MILWAUKE / Prospect Medical Commons - Express Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051BV
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
4/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
2311 N PROSPECT AVE
Suite 2C
MILWAUKEE, WI 53211
Billing Address
Columbia St. Mary's Hospital Milwaukee
2323 N Lake Dr
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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