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DSH520177P FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Terminated)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
Delivery Room & Labor Room
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177P
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/25/2017
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
9000 West Wisconsin Avenue
Milwaukee, WI 53226
Billing Address
Froedtert Memorial Lutheran Hospital
9200 West Wisconsin Avenue
Milwaukee, WI 53226
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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