340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WFH-PE AND FW
DSH520136 Ascension SE Wisconsin Hospital, Inc.
Print
Covered Entity Details
Entity Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
ST. JOSEPH CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH520136
Entity Address
5000 WEST CHAMBERS STREET
MILWAUKEE, WI 53210
Medicare Provider Number
520136
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
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
4/8/2014
Contract Begin Date
7/1/2014
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
James Gresham, Senior Vice President
(414) 874-6277
Contract Pharmacy Representative
Jay D. Rice, Vice President
(414) 874-6217
Signed By Date
4/8/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session