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WHEATON FRANCISCAN INFUSION PHARMACY
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
WHEATON FRANCISCAN INFUSION PHARMACY
Pharmacy Address
ST. JOSEPH REGIONAL MEDICAL CENTER
5000 W. CHAMBERS ST.
MILWAUKEE, WI 53210
Pharmacy Comments
Contract Details
Approval Date
4/8/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2017
Pharmacy closed
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
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