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DSH520051CC COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
6000554904/Cancer Center MDC SMO
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051CC
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/28/2017
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
13111 N. Port Washington Rd.
Mequon, WI 53097
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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