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DSH520177T FROEDTERT MEMORIAL LUTHERAN HOSPITAL (Active)
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Main Details
Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FMLH CANCER CENTER WEST BEND - Medical Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520177T
Medicare Provider Number
520177
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/22/2021
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
3200 PLEASANT VALLEY RD
STE A
WEST BEND, WI 53095-9274
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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