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DSH520177R FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Active)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FMLH INFUSION CLINIC DREXEL TOWN SQ - Drexel TSHC-General Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177R
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/6/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/9/2019
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Froedtert Memorial Lutheran Hospital
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Primary Contact
Froedtert Memorial Lutheran Hospital
Casey Drake Spitzer, 340B Manager
(920) 319-6030
Addresses
Street Address
7901 S 6TH ST
2ND FLOOR STE 20403
OAK CREEK, WI 53154-2010
Billing Address
Froedtert Memorial Lutheran Hospital
9200 West Wisconsin Avenue
PO Box 26099
Milwaukee, WI 53226
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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