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DSH520051BZ COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
CSM Radiation Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051BZ
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
7/31/2017
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
2350 N LAKE DR
Suite G01
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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