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WFH-PE AND FW
DSH520096 Ascension All Saints Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension All Saints Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520096
Entity Address
3801 SPRING STREET
RACINE, WI 53405
Medicare Provider Number
520096
Participating Start Date
4/1/2004
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WFH-PE AND FW
Pharmacy Address
DBA: WHEATON FRANCISCAN PHARMACY
13950 W. CAPITOL DR.
BROOKFIELD, WI 53005-2441
Pharmacy Comments
12/29/10 - CHANGED PHARM NAME FROM MARIAN FRANCISCAN CENTER, INC. (DBA - WHEATON FRANCISCAN PHARMACY) AND ADDRESS FROM 9632 W. APPLETON AVE., MILWAUKEE, WI 53225 BASED ON 12/28 E-MAIL FROM CE.
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jon Sohn, CFO
(414) 465-3090
Contract Pharmacy Representative
Jay D. Rice, Vice President
(414) 874-6217
Signed By Date
10/11/2013
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