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AURORA PRESCRIPTION DISPENSING CENTER
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 PRESCRIPTION DISPENSING CENTER
Pharmacy Address
AURORA PHARMACY INC
2707 15TH PLACE SUITE 101
KENOSHA, WI 53140
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GAIL HANSON, CFO
(414) 299-1623
Contract Pharmacy Representative
Aurora Health Care
Angela De Ianni, Director, Pharmacy Supply Chain
(414) 382-1854
Signed By Date
7/11/2017
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