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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 1106
201 N MAYFAIR RD
WAUWATOSA, WI 53226-4216
Pharmacy Comments
01/15/2014 - Pharmacy name and address correction, changed in error on 3/28/2013, see history for details.
Contract Details
Approval Date
1/6/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathon Matuszewski, Hospital President
(414) 647-5106
Contract Pharmacy Representative
Ascension
Kristopher Cyr, Manager Pharmacy Operations
(262) 687-2151
Signed By Date
1/6/2025
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