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RRC520049-01 BELLIN MEMORIAL HOSPITAL (Active)
Main Details
Name
BELLIN MEMORIAL HOSPITAL
Subdivision Name
BELLIN MEMORIAL HOSPITAL INC - Wound Healing
Type
Rural Referral Center
Rural
No
340B ID
RRC520049-01
Medicare Provider Number
520049
Outpatient Facility Provider Number
Contacts
Authorizing Official
Bellin Memorial Hospital Inc
Sharla Baenen, Chief Operating Officer
(920) 433-7549
Primary Contact
Bellin Memorial Hosital Inc
Alar Laura, Director of Pharmacy
(920) 433-3635
Additional Details
Current Program Status
Active
Registration Date
10/11/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/21/2023
Last Recertification Date
Addresses
Street Address
744 S WEBSTER AVE
GREEN BAY, WI 54301-3505
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2024
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