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DSH520051CP COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
CSM Thoracic Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051CP
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/25/2021
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ascension Columbia St. Mary's
Andre Storey, President
(414) 585-1374
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
2350 N. Lake Dr.
Suite 201
Milwaukee, WI 53211
Billing Address
Columbia St. Mary's Hospital Milwaukee, Inc.
2323 N. Lake Drive
Milwaukee, WI 53211
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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