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AURORA SPECIALTY PHARMACY
DSH520139 West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
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Covered Entity Details
Entity Name
West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520139
Entity Address
8901 West Lincoln Avenue
West Allis, WI 53227
Medicare Provider Number
520139
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
AURORA SPECIALTY PHARMACY
Pharmacy Address
N93W14575 WHITTAKER WAY
MENOMONEE FALLS, WI 53051-1652
Pharmacy Comments
Contract Details
Approval Date
3/23/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
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
3/23/2017
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