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DSH520136CV Ascension SE Wisconsin Hospital, Inc. (Terminated)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
St. Joseph Campus / Professional Office Building (POB) OB/GYN - OB/GYN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136CV
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
4/1/2021
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
3070 N. 51st St.
Suite G100
Milwaukee, WI 53210-1645
Billing Address
WHEATON FRANCISCAN, INC.
5000 W. Chambers St.
Milwaukee, WI 53210
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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