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ASCENSION WISCONSIN PHARMACY, INC.
DSH520078 Ascension St. Francis Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension St. Francis Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520078
Entity Address
3237 SOUTH 16TH STREET
MILWAUKEE, WI 53215
Medicare Provider Number
520078
Participating Start Date
10/1/2006
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
ASCENSION WISCONSIN PHARMACY, INC.
Pharmacy Address
DBA/ ASCENSION RX 1107
3237 S 16TH ST RM 121
MILWAUKEE, WI 53215-4526
Pharmacy Comments
Contract Details
Approval Date
6/15/2008
Contract Begin Date
6/15/2008
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM PONG, SYSTEM DIRECTOR - PHARMACY SERVICES
(414) 647-7461
Contract Pharmacy Representative
JAMES D. GRESHAM, PRESIDENT - CCAS
(414) 647-5300
Signed By Date
6/5/2008
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