Contract Pharmacy Details

ACCREDO HEALTH GROUP INC
DSH520136 Ascension SE Wisconsin Hospital, Inc.

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

ACCREDO HEALTH GROUP INC

Pharmacy Address

2040 W RIO SALADO PKWY STE 101B
TEMPE, AZ 85281-2010

Pharmacy Comments

Contract Details

Approval Date

4/4/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sharon Baughman, Senior Vice President /Chief Nursing Officer
(414) 447-2719

Contract Pharmacy Representative

Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

4/4/2017

340B Drug Pricing Program Database