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SCH520088-00 SSM HEALTH ST AGNES HOSPITAL - FOND DU LAC (Active)
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Main Details
Name
SSM HEALTH ST AGNES HOSPITAL - FOND DU LAC
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH520088-00
Medicare Provider Number
520088
Additional Details
Current Program Status
Active
Registration Date
7/7/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/12/2023
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
SSM Health
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Primary Contact
SSM Health
Michelle Nicole Schmitt, Director of Business Operations
(608) 294-6203
Addresses
Street Address
430 EAST DIVISION STREET
FOND DU LAC, WI 54935
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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