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RRC520049-00 BELLIN MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
BELLIN MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC520049-00
Medicare Provider Number
520049
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/21/2023
Last Recertification Date
9/6/2024
Termination Date
Termination Reason
4/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Bellin Memorial Hospital Inc
Sharla Baenen, Chief Operating Officer
(920) 433-7549
Primary Contact
Bellin Memorial Hospital Inc
Alar Laura, Director of Pharmacy
(920) 433-3635
Addresses
Street Address
744 S WEBSTER AVENUE
GREEN BAY, WI 54301-3400
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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