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DSH520098AB UNIVERSITY OF WI HOSPITALS & CLINICS (Terminated)
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Main Details
Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
U STATION - IMAGING - DIAGNOSTIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520098AB
Medicare Provider Number
520098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/2/2022
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
4/1/2023
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
2880 UNIVERSITY AVE
MADISON, WI 53705
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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