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PICK 'N SAVE PHARMACY 6366
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
PICK 'N SAVE PHARMACY 6366
Pharmacy Address
MEGA MARTS, LLC
5800 S. 108TH STREET
HALES CORNERS, WI 53130
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/5/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/14/2019
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