Covered Entity Details

CAH361307-01 UH GENEVA MEDICAL CENTER (Terminated) - information as of 6/14/2025 10:08:50 AM

Main Details

Name

UH GENEVA MEDICAL CENTER

Subdivision Name

UH Geneva Ashtabula Urgent Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH361307-01

Medicare Provider Number

361307

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/14/2015

Participating Start Date

10/1/2015

Participating Approval Date

8/11/2015

Last Recertification Date

8/31/2016

Termination Date
Termination Reason

10/1/2017
Site closure

Contacts

Authorizing Official

UH
Michael R. Vehovec, Corporate Controller
(216) 767-8729

Primary Contact

MATTHEW JULIEN, FAII
(216) 767-8798

Addresses

Street Address

2131 Lake Avenue
Ashtabula, OH 44004

Billing Address

UH Geneva Medical Center
870 W Main Street
Geneva, OH 44041-1219

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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	5874568

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH361307-01	Child	CAH	UH GENEVA MEDICAL CENTER	UH Geneva Ashtabula Urgent Care	2131 Lake Avenue	Ashtabula	OH	Terminated

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Vehovec, Michael R. Corporate Controller 2167678729	Vehovec, Michael R. Corporate Controller UH 2167678729	10/20/2017 11:35 AM
Contacts	Signed By	Update	Vehovec, Michael R. Corporate Controller 2167678729	Vehovec, Michael R. Corporate Controller UH 2167678729	10/20/2017 11:35 AM
Contacts	Authorizing Official	Insert		Vehovec, Michael R. Corporate Controller 2167678729	7/26/2017 4:12 PM
Contacts	Signed By	Insert		Vehovec, Michael R. Corporate Controller 2167678729	7/26/2017 4:12 PM
Addresses	Main Address	Insert		2131 Lake Avenue Ashtabula, OH 44004	7/25/2017 8:19 AM
Addresses	Billing Address	Insert		UH Geneva Medical Center 870 W Main Street Geneva, OH 44041-1219	7/25/2017 8:19 AM
Contacts	Primary Contact	Update	TAYLOR, JOHN E. DIRECTOR OF REIMBURSEMENT 2167678793	JULIEN, MATTHEW FAII 2167678798	7/25/2017 8:19 AM
Details	State	Update	To Be Terminated	Terminated	7/25/2017 8:19 AM
Dates	Last Date That 340B Drugs Purchased	Update		7/1/2017 12:00:00 AM	7/25/2017 8:19 AM
Details	State	Update	Active	To Be Terminated	7/25/2017 8:19 AM
Terminations	Termination Comments	Update		Ownership changing to another entity	7/25/2017 8:19 AM
Terminations	Termination Date	Update		10/1/2017 12:00:00 AM	7/25/2017 8:19 AM
Terminations	Termination Effective Date	Update		7/1/2017 12:00:00 AM	7/25/2017 8:19 AM
Terminations	Termination Reason	Update		Site closure	7/25/2017 8:19 AM
Contacts	Primary Contact	Insert		TAYLOR, JOHN E. DIRECTOR OF REIMBURSEMENT 2167678793	9/1/2016 10:14 AM
Details	Last Recertification Date	Update		8/31/2016 12:00:00 AM	8/31/2016 11:54 AM
Dates	Participating Approval Date	Update		8/11/2015 12:00:00 AM	8/11/2015 10:35 AM
Details	State	Update	Pending	Active	8/11/2015 10:35 AM
Dates	Start Date	Update		10/1/2015 12:00:00 AM	8/11/2015 10:35 AM
Details	340B ID	Update	OUTPATIENT_ONLINE_REG_53651	CAH361307-01	8/10/2015 1:56 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_53651	7/14/2015 3:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	7/14/2015 3:32 PM
Medicaid Billing	Medicaid: Number	Insert		5874568	7/14/2015 3:32 PM
Medicaid Billing	Medicaid: State	Insert		OH	7/14/2015 3:32 PM
Details	Last Recertification Date	Insert			7/14/2015 3:32 PM
Details	Grant Number	Insert			7/14/2015 3:32 PM
Details	340B ID	Insert			7/14/2015 3:32 PM
Details	Is Authorizing Official EHB Data	Insert			7/14/2015 3:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert			7/14/2015 3:32 PM
Details	Medicare Provider Number	Insert		361307	7/14/2015 3:32 PM
Details	Entity Name	Insert		UH GENEVA MEDICAL CENTER	7/14/2015 3:32 PM
Details	Program Code	Insert		CAH	7/14/2015 3:32 PM
Details	Entity Subname	Insert		UH Geneva Ashtabula Urgent Care	7/14/2015 3:32 PM
Dates	Participating Approval Date	Insert			7/14/2015 3:32 PM
Details	State	Insert		Pending	7/14/2015 3:32 PM
Dates	Registration Date	Insert		7/14/2015 12:00:00 AM	7/14/2015 3:32 PM
Dates	Signed By Date	Insert		7/14/2015 12:00:00 AM	7/14/2015 3:32 PM
Dates	Start Date	Insert			7/14/2015 3:32 PM
Terminations	Termination Comments	Insert			7/14/2015 3:32 PM
Terminations	Termination Date	Insert			7/14/2015 3:32 PM
Terminations	Termination Effective Date	Insert			7/14/2015 3:32 PM
Terminations	Termination Reason	Insert			7/14/2015 3:32 PM