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WAL-MART PHARMACY 10-1394
DSH520078 Ascension St. Francis Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension St. Francis Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520078
Entity Address
3237 SOUTH 16TH STREET
MILWAUKEE, WI 53215
Medicare Provider Number
520078
Participating Start Date
10/1/2006
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1394
Pharmacy Address
10600 W LAYTON AVE
GREENFIELD, WI 53228
Pharmacy Comments
12/10/2012 address update (was 4500 S 108TH ST)
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/29/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/13/2018
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