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DSH520051EE COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC (Active)
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Main Details
Name
COLUMBIA ST MARYS HOSPITAL MILWAUKEE, INC
Subdivision Name
CSMO Hospital Wound Care - Wound Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520051EE
Medicare Provider Number
520051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/3/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/12/2023
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
13111 N. Port Washington Rd.
Mequon, WI 53097
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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