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METRO MARKET PHARMACY #6887
DSH520177 FROEDTERT MEMORIAL LUTHERAN HOSPITAL
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Covered Entity Details
Entity Name
FROEDTERT MEMORIAL LUTHERAN HOSPITAL
Subdivision Name
FORMERLY JOHN L. DOYNE HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH520177
Entity Address
9200 WEST WISCONSIN AVENUE
MILWAUKEE, WI 53226
Medicare Provider Number
520177
Participating Start Date
7/1/1996
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
METRO MARKET PHARMACY #6887
Pharmacy Address
4279 S 76TH ST
GREENFIELD, WI 53220
Pharmacy Comments
Contract Details
Approval Date
7/16/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Van De Kreeke, Vice President, Finance
(414) 777-0968
Contract Pharmacy Representative
Edward G. Kitz, GVP Legal, Risk and Treasury, G&A
(414) 231-5901
Signed By Date
7/16/2013
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