340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH520136CX Ascension SE Wisconsin Hospital, Inc. (Terminated)
Print
Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
Observation - Elmbrook Acute Rehab - Rehabilitation
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136CX
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/21/2019
Last Recertification Date
9/9/2019
Termination Date
Termination Reason
4/1/2020
Other
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
19333 West North Avenue
Brookfield, WI 53045-4132
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session