Contract Pharmacy Details

WFH-PE AND FW
DSH520078 Ascension St. Francis Hospital, Inc.

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

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

340B Drug Pricing Program Database