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AURORA PHARMACY
DSH520138 AURORA HEALTH CARE METRO, INC.
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Covered Entity Details
Entity Name
AURORA HEALTH CARE METRO, INC.
Subdivision Name
Aurora St. Luke's Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH520138
Entity Address
2900 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Medicare Provider Number
520138
Participating Start Date
10/1/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AURORA PHARMACY
Pharmacy Address
WEST ALLIS MEDICAL OFFICE
2424 S 90TH ST
WEST ALLIS, WI 53227-2455
Pharmacy Comments
Contract Details
Approval Date
10/11/2011
Contract Begin Date
10/11/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David G. Yeager, Secretary/Treasurer
(414) 649-6797
Contract Pharmacy Representative
Thomas W. Woller, SVP, Pharmacy Services
(414) 382-1829
Signed By Date
9/28/2011
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