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ST JOSEPH'S COMM HOSPITAL
DSH520177 FROEDTERT MEMORIAL LUTHERAN HOSPITAL
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Covered Entity Details
Entity Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FORMERLY JOHN L. DOYNE HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH520177
Entity Address
9200 WEST WISCONSIN AVENUE
MILWAUKEE, WI 53226
Medicare Provider Number
520177
Participating Start Date
7/1/1996
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S COMM HOSPITAL
Pharmacy Address
INPATIENT PHARMACY
3200 PLEASANT VALLEY RD
WEST BEND, WI 53095-9274
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Klauck, Senior Vice President, Ancillary Services
(414) 777-1925
Contract Pharmacy Representative
Froedtert & the Medical College of Wisconsin
Kate Schaafsma, Director of Pharmacy, Community Hospital Division
(262) 257-4579
Signed By Date
7/8/2020
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