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DSH520177L FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Terminated)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL / Rheumatology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177L
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/18/2016
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
Froedtert Memorial Lutheran Hospital
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Primary Contact
Froedtert Memorial Lutheran Hospital
Jacob Olson, 340B Program Manager
(262) 532-5184
Addresses
Street Address
9200W WISCONSIN AVE
MILWAUKEE, WI 53226-3522
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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