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DSH520009U Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus (Terminated)
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Main Details
Name
Ascension NE Wisconsin, Inc. d/b/a Ascension NE Wisconsin - St. Elizabeth Hospital Campus
Subdivision Name
ASCENSION NE WISCONSIN-MERCY CAMPUS - Pheresis - Pheresis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520009U
Medicare Provider Number
520009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/9/2022
Last Recertification Date
Termination Date
Termination Reason
4/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Ascension
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
500 S. Oakwood Rd
Oshkosh, WI 54904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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