Covered Entity Details

SCH360197-01 MARY RUTAN HOSPITAL (Terminated) - information as of 4/27/2025 11:36:52 PM

Main Details

Name

MARY RUTAN HOSPITAL

Subdivision Name

CRAWFIS ONCOLOGY CLINIC

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH360197-01

Medicare Provider Number

360197

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

9/29/2010

Participating Start Date

9/30/2010

Participating Approval Date

9/30/2010

Last Recertification Date

8/5/2015

Termination Date
Termination Reason

4/1/2016
Site closure

Contacts

Authorizing Official

Mary Rutan Hospital
Steven R. Brown, CFO, VP FINANCIAL SERVICES
(937) 599-7001

Primary Contact

Melannie Hunsicker, Director of Pharmacy
(937) 599-7054

Addresses

Street Address

2160 EWING CRAWFIS CIRCLE
BELLEFONTAINE, OH 43311

Billing Address

MARY RUTAN HOSPITAL
P.O. BOX 951434
CLEVELAND, OH 44193

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
9/28/2010 - DOC RECEIVED TO CONFIRM ELIG DSH ADJ %	09/30/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

MARY RUTAN HOSPITAL
205 PALMER AVE
BELLEFONTAINE, OH 43311

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH360197-01	Child	SCH	MARY RUTAN HOSPITAL	CRAWFIS ONCOLOGY CLINIC	2160 EWING CRAWFIS CIRCLE	BELLEFONTAINE	OH	Terminated
SCH360197-02	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL PHYSICAL REHABILITATION CENTER	1134 N. Main St.	BELLEFONTAINE	OH	Terminated
SCH360197-03	Child	SCH	MARY RUTAN HOSPITAL	CRAWFIS IMAGING CENTER	120 DOWELL AVE.	BELLEFONTAINE	OH	Terminated
SCH360197-10	Child	SCH	MARY RUTAN HOSPITAL	General Surgery	2160 Ewing Crawfis Circle	Bellefontaine	OH	Terminated
SCH360197-11	Child	SCH	MARY RUTAN HOSPITAL	Pediatrics	118 Dowell Ave	BELLEFONTAINE	OH	Terminated
SCH360197-12	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL OBGYN	1125 RUSH AVE	BELLEFONTAINE	OH	Terminated
SCH360197-13	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL UROLOGY	2160 EWING CRAWFIS CIR	BELLEFONTAINE	OH	Terminated
SCH360197-14	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL ORTHOPEDICS	2221 TIMBER TRAIL	BELLEFONTAINE	OH	Terminated
SCH360197-15	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL INTERNAL MEDICI	2231 TIMBER TRAIL	BELLEFONTAINE	OH	Terminated
SCH360197-16	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL EAR, NOSE & THR	921 E SANDUSKY AVENUE	BELLEFONTAINE	OH	Terminated
SCH360197-17	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL / Urbana Clinic	1880 E. US Hwy 36	URBANA	OH	Terminated
SCH360197-18	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL NEUROLOGY	2160 EWING CRAWFIS CIR	BELLEFONTAINE	OH	Terminated
SCH360197-19	Child	SCH	MARY RUTAN HOSPITAL	MARY RUTAN HOSPITAL - Urgent Care	1134 N MAIN ST	BELLEFONTAINE	OH	Terminated

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Brown, Steven R. CFO, VP FINANCIAL SERVICES 9375997001	Brown, Steven R. CFO, VP FINANCIAL SERVICES Mary Rutan Hospital 9375997001	10/2/2017 12:25 PM
Contacts	Authorizing Official	Insert		Brown, Steven R. CFO, VP FINANCIAL SERVICES 9375997001	10/28/2016 10:44 AM
Contacts	Primary Contact	Insert		Hunsicker, Melannie Director of Pharmacy 9375997054	10/28/2016 10:44 AM
Addresses	Main Address	Insert		2160 EWING CRAWFIS CIRCLE BELLEFONTAINE, OH 43311	2/11/2016 7:20 AM
Addresses	Billing Address	Insert		MARY RUTAN HOSPITAL P.O. BOX 951434 CLEVELAND, OH 44193	2/11/2016 7:20 AM
Addresses	Shipping Address	Insert		MARY RUTAN HOSPITAL 205 PALMER AVE BELLEFONTAINE, OH 43311	2/11/2016 7:20 AM
Dates	Last Date That 340B Drugs Purchased	Update		5/26/2015 12:00:00 AM	2/11/2016 7:20 AM
Details	State	Update	Active	Terminated	2/11/2016 7:20 AM
Terminations	Termination Date	Update		4/1/2016 12:00:00 AM	2/11/2016 7:20 AM
Terminations	Termination Effective Date	Update		5/28/2015 12:00:00 AM	2/11/2016 7:20 AM
Terminations	Termination Reason	Update		Site closure	2/11/2016 7:20 AM
Details	Last Recertification Date	Update	9/4/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 2:02 PM
Details	Last Recertification Date	Update	8/30/2013 12:55:31 PM	9/4/2014 12:00:00 AM	9/4/2014 11:55 AM
Details	Last Recertification Date	Update	7/1/2012 12:00:00 AM	8/30/2013 12:55:31 PM	8/30/2013 12:55 PM
Details	Entity Subname	Update	EWING H. CRAWFIS ONCOLOGY CLINIC	CRAWFIS ONCOLOGY CLINIC	7/10/2013 11:35 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	5/9/2012 8:45 AM
Details	Last Recertification Date	Insert			9/30/2010 8:42 AM
Details	Grant Number	Insert			9/30/2010 8:42 AM
Details	340B ID	Insert		SCH360197-01	9/30/2010 8:42 AM
Details	Is Authorizing Official EHB Data	Insert			9/30/2010 8:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert			9/30/2010 8:42 AM
Details	Medicare Provider Number	Insert		360197	9/30/2010 8:42 AM
Details	Entity Name	Insert		MARY RUTAN HOSPITAL	9/30/2010 8:42 AM
Details	Program Code	Insert		SCH	9/30/2010 8:42 AM
Details	Entity Subname	Insert		EWING H. CRAWFIS ONCOLOGY CLINIC	9/30/2010 8:42 AM
Dates	Participating Approval Date	Insert		9/30/2010 12:00:00 AM	9/30/2010 8:42 AM
Details	State	Insert		Active	9/30/2010 8:42 AM
Dates	Registration Date	Insert		9/29/2010 12:00:00 AM	9/30/2010 8:42 AM
Dates	Signed By Date	Insert		9/27/2010 12:00:00 AM	9/30/2010 8:42 AM
Dates	Start Date	Insert		9/30/2010 12:00:00 AM	9/30/2010 8:42 AM
Terminations	Termination Comments	Insert			9/30/2010 8:42 AM
Terminations	Termination Date	Insert			9/30/2010 8:42 AM
Terminations	Termination Effective Date	Insert			9/30/2010 8:42 AM
Terminations	Termination Reason	Insert			9/30/2010 8:42 AM
Details	Comments Public	Insert		9/28/2010 - DOC RECEIVED TO CONFIRM ELIG DSH ADJ %	9/30/2010 8:42 AM