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DSH520136CY Ascension SE Wisconsin Hospital, Inc. (Terminated)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
Observation - Wauwatosa Pulmonary Rehab - Pulmonary Rehabilitation
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136CY
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
8/23/2023
Termination Date
Termination Reason
4/1/2024
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
201 N. Mayfair Rd.
Wauwatosa, WI 53226-4216
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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