Contract Pharmacy Details

ALTSCRIPTS SPECIALTY PHARMACY
DSH520075 ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Covered Entity Details

Entity Name

ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520075

Entity Address

835 S.VAN BUREN STREET
GREEN BAY, WI 54301

Medicare Provider Number

520075

Participating Start Date

1/1/2010

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

ALTSCRIPTS SPECIALTY PHARMACY

Pharmacy Address

1636 MILLER PARK WAY
WEST MILWAUKEE, WI 53214-3604

Pharmacy Comments

Contract Details

Approval Date

1/12/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Joanne Horvath, Vice President - Finance
(920) 431-3211

Contract Pharmacy Representative

Altscripts Specialty Pharmacy
Jamie Shaw, Director of Compliance
(414) 469-8333

Signed By Date

1/12/2017

340B Drug Pricing Program Database