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DSH520051CH COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Terminated)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
Cardiothoracic Surgery SMO/ 6000648007 - Cardiothoracic Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051CH
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/2/2018
Last Recertification Date
9/12/2022
Termination Date
Termination Reason
4/1/2023
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
13133 N. Port Washington Road
Suite 116
Mequon, WI 53097
Billing Address
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
2323 N Lake Dr.
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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