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AURORA PHARMACY INC
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 INC
Pharmacy Address
DBA AURORA PHARMACY
3900 ERIE STREET
RACINE, WI 53402
Pharmacy Comments
Contract Details
Approval Date
2/22/2012
Contract Begin Date
2/22/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/17/2017
Pharmacy closed
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
2/22/2012
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