Covered Entity Details

CH05058B NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC. (Active) - information as of 4/26/2025 11:41:17 PM

Main Details

Name

NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Subdivision Name

SUPERIOR HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003439

340B ID

CH05058B

Grant Number

H80CS00191

Additional Details

Current Program Status

Active

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

12/1/1992

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Northeast Ohio Neighborhood Health Services, Inc.
Willie F. Austin, President/CEO
(216) 231-7700 Ext: 1112

Primary Contact

NEON
Anita Watson, Medical Director
(216) 231-7700 Ext: 1004

Addresses

Street Address

12100 Superior Ave
Cleveland, OH 44106-1444

Billing Address

Northeast Ohio Neighborhood Health Services INC
4800 Payne Avenue
Cleveland, OH 44103

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OH	0826708	1659407682

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH050580	Active	BPS-H80-001866	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES	8300 Hough Ave	Cleveland	OH
CH05058B	Active	BPS-H80-003439	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	SUPERIOR HEALTH CENTER	12100 Superior Ave	Cleveland	OH
CH05058E	Active	BPS-H80-000739	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	COLLINWOOD HEALTH CENTER	15322 Saint Clair Ave	Cleveland	OH
CH05058F	Active	BPS-H80-002261	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	SOUTHEAST HEALTH CENTER	13301 Miles Ave	Cleveland	OH
CH05058G	Active	BPS-H80-002858	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	NORWOOD HEALTH CENTER	1468 E 55th St	Cleveland	OH
CH05058H	Active	BPS-H80-001840	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	EAST CLEVELAND HEALTH CENTER	15201 Euclid Ave	Cleveland	OH
CH05058J	Active	BPS-H80-012514	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	Miles Broadway Health Center	9127 Miles Ave	Cleveland	OH
CH05058K	Active	BPS-H80-012742	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	NEON Dental Mobile Unit	15320 Euclid Avenue	East Cleveland	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH050580	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	07/01/2022
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07370	4460 MAYFIELD RD.	SOUTH EUCLID	OH	44121	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03346	17120 CHAGRIN BLVD	SHAKER HEIGHTS	OH	44120	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04803	8000 EUCLID AVE.	CLEVELAND	OH	44103	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03337	3825 MONTICELLO BLVD	CLEVELAND HEIGHTS	OH	44121	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04316	6301 HARVARD AVENUE	CLEVELAND	OH	44105	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05366	10825 KINSMAN RD.	CLEVELAND	OH	44104	04/01/2021	07/08/2024
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03338	22001 LAKESHORE BLVD	EUCLID	OH	44123	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03634	2160 LEE RD	CLEVELAND HEIGHTS	OH	44118	04/01/2021
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04499	1443 RICHMOND RD.	LYNDHURST	OH	44124	07/01/2024
CH050580	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04350	13215 SHAKER SQUARE	CLEVELAND	OH	44120	10/01/2024
CH050580	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2021
CH050580	RITE AID OF OHIO, INC.	RITE AID #3156	15105 SAINT CLAIR AVENUE	CLEVELAND	OH	44110	07/01/2014	04/02/2018
CH050580	RITE AID OF OHIO, INC.	RITE AID #2640	5411 SUPERIOR AVENUE	CLEVELAND	OH	44103	07/01/2014
CH050580	RITE AID OF OHIO, INC.	RITE AID #2665	10502 SAINT CLAIR AVENUE	CLEVELAND	OH	44108	07/01/2014
CH050580	RITE AID OF OHIO, INC.	RITE AID #3043	10090 CHESTER AVE	CLEVELAND	OH	44106	07/01/2014
CH050580	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	01/01/2013	07/10/2015
CH050580	WALGREEN CO.	DBA: WALGREENS #21259	14501 EUCLID AVE	EAST CLEVELAND	OH	44112-3426	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 03312	22401 LAKE SHORE BLVD	EUCLID	OH	44123	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 04130	3020 MAYFIELD ROAD	CLEVELAND HEIGHTS	OH	44118	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 06659	4071 LEE RD BLDG A-1	CLEVELAND	OH	44128	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 10710	20485 EUCLID AVE	EUCLID	OH	44117	08/17/2012
CH050580	WALGREEN CO.	DBA: WALGREENS # 03256	11401 UNION AVENUE	CLEVELAND	OH	44105	07/01/2018
CH050580	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2025
CH050580	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/10/2015
CH050580	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013
CH050580	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH050580	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/15/2024 10:57:33 AM	2/12/2025 12:48:32 PM	2/12/2025 12:48 PM
Details	Last Recertification Date	Update	Recertification	2/8/2023 11:48:08 AM	2/15/2024 10:57:33 AM	2/15/2024 10:57 AM
Details	Last Recertification Date	Update	Recertification	2/22/2022 3:54:47 PM	2/8/2023 11:48:08 AM	2/8/2023 11:48 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 4:46:58 PM	2/22/2022 3:54:47 PM	2/22/2022 3:54 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/4/2021 4:46 PM
Details	Last Recertification Date	Update	Recertification	2/4/2020 3:35:11 PM	2/4/2021 4:46:58 PM	2/4/2021 4:46 PM
Details	Last Recertification Date	Update	Recertification	2/21/2019 4:54:51 PM	2/4/2020 3:35:11 PM	2/4/2020 3:35 PM
Addresses	Billing Address	Insert	Recertification		Northeast Ohio Neighborhood Health Services INC 4800 Payne Avenue Cleveland, OH 44103	2/21/2019 4:54 PM
Details	Last Recertification Date	Update	Recertification	2/28/2018 12:02:16 PM	2/21/2019 4:54:51 PM	2/21/2019 4:54 PM
Details	Last Recertification Date	Update	Recertification	2/6/2017 12:00:00 AM	2/28/2018 12:02:16 PM	2/28/2018 12:02 PM
Contacts	Authorizing Official	Update		Austin, Willie F. President/CEO 2162317700-1112	Austin, Willie F. President/CEO Northeast Ohio Neighborhood Health Services, Inc. 2162317700-1112	10/13/2017 10:52 AM
Contacts	Primary Contact	Update		Watson, Anita Medical Director 2162317700-1004	Watson, Anita Medical Director NEON 2162317700-1004	10/6/2017 4:29 PM
Contacts	Authorizing Official	Insert			Austin, Willie F. President/CEO 2162317700-1112	2/6/2017 2:23 PM
Contacts	Primary Contact	Update		BATSON, MARK CHIEF OPERATING OFFICER 2162317700	Watson, Anita Medical Director 2162317700-1004	2/6/2017 2:23 PM
Addresses	Main Address	Insert			12100 Superior Ave Cleveland, OH 44106-1444	2/6/2017 1:50 PM
Details	Last Recertification Date	Update		2/18/2016 12:00:00 AM	2/6/2017 12:00:00 AM	2/6/2017 1:50 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/18/2016 11:40 AM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/18/2016 12:00:00 AM	2/18/2016 11:40 AM
Medicaid Billing	NPI: Number	Insert			1659407682	2/3/2015 1:01 PM
Details	Last Recertification Date	Update		3/20/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 1:01 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/20/2014 12:00:00 AM	3/20/2014 2:15 PM
Details	Entity Name	Update		NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.	3/20/2014 2:15 PM
Details	Entity Subname	Update		SUPERIOR CENTER/HN III	SUPERIOR HEALTH CENTER	3/20/2014 2:15 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/12/2013 11:49 AM
Contacts	Primary Contact	Insert			BATSON, MARK CHIEF OPERATING OFFICER 2162317700	1/21/2010 11:32 AM
Details	Last Recertification Date	Insert				3/7/2006 11:23 AM
Details	Grant Number	Insert			H80CS00191	3/7/2006 11:23 AM
Details	340B ID	Insert			CH05058B	3/7/2006 11:23 AM
Details	Is Authorizing Official EHB Data	Insert				3/7/2006 11:23 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/7/2006 11:23 AM
Details	Medicare Provider Number	Insert				3/7/2006 11:23 AM
Details	Entity Name	Insert			NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES	3/7/2006 11:23 AM
Details	Program Code	Insert			CH	3/7/2006 11:23 AM
Details	Entity Subname	Insert			SUPERIOR CENTER/HN III	3/7/2006 11:23 AM
Dates	Participating Approval Date	Insert			12/1/1992 12:00:00 AM	3/7/2006 11:23 AM
Details	State	Insert			Active	3/7/2006 11:23 AM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	3/7/2006 11:23 AM
Dates	Signed By Date	Insert				3/7/2006 11:23 AM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	3/7/2006 11:23 AM
Terminations	Termination Comments	Insert				3/7/2006 11:23 AM
Terminations	Termination Date	Insert				3/7/2006 11:23 AM
Terminations	Termination Effective Date	Insert				3/7/2006 11:23 AM
Terminations	Termination Reason	Insert				3/7/2006 11:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			0826708	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: State	Insert			OH	12/1/1992 12:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History