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RRC520198-07 AURORA MEDICAL CENTER OF OSHKOSH (Terminated)
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Main Details
Name
AURORA MEDICAL CENTER OF OSHKOSH
Subdivision Name
AURORA PHYSICAL THERAPY - Physical Medicine Rehab
Type
Rural Referral Center
Rural
Yes
340B ID
RRC520198-07
Medicare Provider Number
520198
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/15/2021
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765
Primary Contact
Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457
Addresses
Street Address
712 DOCTORS CT
OSHKOSH, WI 54901-2029
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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