Contract Pharmacy Details

WAL-MART PHARMACY 10-3322
DSH520078 Ascension St. Francis Hospital, Inc.

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 10-3322

Pharmacy Address

411 PEWAUKEE ROAD
PEWAUKEE, WI 53072

Pharmacy Comments

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

340B Drug Pricing Program Database