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HSHS PHARMACY #101
DSH520075 ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS
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Covered Entity Details
Entity Name
ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520075
Entity Address
835 S.VAN BUREN STREET
GREEN BAY, WI 54301
Medicare Provider Number
520075
Participating Start Date
1/1/2010
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
HSHS PHARMACY #101
Pharmacy Address
855 S MAIN ST
OCONTO FALLS, WI 54154-1241
Pharmacy Comments
Contract Details
Approval Date
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patty Allen, Chief Financial Officer
(920) 884-5660
Contract Pharmacy Representative
HSHS St. Clare Memorial Hospital
Heidi Cole, Pharmacy Supervisor
(920) 846-8059 Ext: 30342
Signed By Date
4/13/2023
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