Contract Pharmacy Details

WISCONSIN CVS PHARMACY, L.L.C.
DSH520138 AURORA HEALTH CARE METRO, INC.

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

WISCONSIN CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03394
3860 S. 27TH ST.
MILWAUKEE, WI 53221

Pharmacy Comments

Contract Details

Approval Date

10/15/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Nan Nelson, SVP-Finance
(414) 378-4765

Contract Pharmacy Representative

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

Signed By Date

10/15/2021

340B Drug Pricing Program Database