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RRC520098-14 UNIVERSITY OF WI HOSPITALS & CLINICS (Terminated)
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Main Details
Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Rehab Clinic-Middleton-REHAB THERAPY - ORTHOTICS
Type
Rural Referral Center
Rural
No
340B ID
RRC520098-14
Medicare Provider Number
520098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/28/2020
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
UW Health
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Primary Contact
UW Health
Jack D Temple, Senior Pharmacy Director
(608) 821-1622
Addresses
Street Address
6630 UNIVERSITY AVE
MIDDLETON, WI 53562-3036
Billing Address
UW Health – Accounts Payable
PO Box 5448
Madison, WI 53705
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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