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DSH520009G Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus (Active)
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Main Details
Name
Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus
Subdivision Name
ASCENSION NE WISCONSIN-MERCY CAMPUS - Breast Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520009G
Medicare Provider Number
520009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/21/2019
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Ascension Wisconsin
Michael Bergmann, President
(920) 831-8913
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
2700 W. 9th Ave
Suite 201
OSHKOSH, WI 54904
Billing Address
ASCENSION NE WISCONSIN-MERCY CAMPUS
500 S. OAKWOOD RD
Oshkosh, WI 54904-7944
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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