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AURORA PHARMACY #1097
DSH520138 AURORA HEALTH CARE METRO, INC.
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Covered Entity Details
Entity Name
AURORA HEALTH CARE METRO, INC.
Subdivision Name
Aurora St. Luke's Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH520138
Entity Address
2900 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Medicare Provider Number
520138
Participating Start Date
10/1/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AURORA PHARMACY #1097
Pharmacy Address
AURORA PHARMACY, INC
12203 CORPORATE PKWY STE 100
MEQUON, WI 53092-3388
Pharmacy Comments
Contract Details
Approval Date
10/11/2020
Contract Begin Date
10/11/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nan Nelson, SVP-Finance
(414) 378-4765
Contract Pharmacy Representative
Advocate Aurora Health Care
Angela De Ianni, Vice President Pharmacy Supply Chain
(414) 630-1541
Signed By Date
10/11/2020
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