Contract Pharmacy Details

WISCONSIN CVS PHARMACY, L.L.C.
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

WISCONSIN CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08773
3030 W VILLARD AVE
MILWAUKEE, WI 53209

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/22/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2020

340B Drug Pricing Program Database