Covered Entity Details

DSH360048 UNIV OF TOLEDO MEDL CENTER (Active) - information as of 6/8/2025 11:56:14 PM

Main Details

Name

UNIV OF TOLEDO MEDL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360048

Medicare Provider Number

360048

Additional Details

Current Program Status

Active

Registration Date

1/12/2016

Participating Start Date

4/1/2016

Participating Approval Date

3/15/2016

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

University of Toledo Medical Center
Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788

Primary Contact

The University of Toledo Medical Center
Holiday Robin Caton, 340B Specialist
(419) 383-3609

Addresses

Street Address

3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589

Billing Address

UNIV OF TOLEDO MEDL CENTER
2801 W. BANCROFT ST.
TOLEDO, OH 43606

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
MI	1811971302	1811971302,1457314502,1154384204
OH	5616506	1811971302,1457314502,1154384204

Shipping Addresses

Shipping Address 1

University of Toledo Medical Center
3333 Glendale Ave
MS 1208
Toledo, OH 43614

Shipping Address 2

University of Toledo Medical Center
3000 Arlington Ave.
Toledo, OH 43614

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/13/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/13/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/13/2018	10/01/2018	09/01/2023	10/02/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/19/2022	07/01/2022		07/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/13/2023	10/01/2023		10/01/2023
Contract Detail	AMBER ENTERPRISES, INC	DBA AMBER SPECIALTY PHARMACY	10004 S 152ND ST STE A	OMAHA	NE	68138-3931	07/13/2018	10/01/2018	10/01/2021	10/15/2021
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/08/2024	07/01/2024		07/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/08/2024	07/01/2024		07/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/08/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/13/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/13/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/13/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/13/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/19/2022	07/01/2022		07/01/2022
Contract Detail	CLINICAL SPECIALTIES INC	6288 HUDSON CROSSING PKWY		HUDSON	OH	44236	07/18/2016	10/01/2016	08/15/2018	08/15/2018
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA TOLEDO IV CARE	4060 TECHNOLOGY DRIVE	MAUMEE	OH	43537	04/13/2020	07/01/2020	11/09/2022	11/14/2022
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/08/2024	07/01/2024		07/01/2024
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/08/2024	07/01/2024		07/01/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/19/2022	07/01/2022		07/01/2022
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/15/2016	10/01/2016	08/01/2022	08/09/2022
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/08/2024	07/01/2024		07/01/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/19/2022	07/01/2022		07/01/2022
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/19/2022	07/01/2022		07/01/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/19/2022	07/01/2022		07/01/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/19/2022	07/01/2022		07/01/2022
Contract Detail	INFUSION PARTNERS	DBA BIOSCRIP INFUSION SERVICES	3315 CENTENNIAL ROAD SUITE AA	SYLVANIA	OH	43560	01/14/2018	04/01/2018		01/14/2018
Contract Detail	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #115	1391 CONANT STREET		MAUMEE	OH	43537-1609	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #116	1725 S. WHEELING STREET		OREGON	OH	43616-3962	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #117	7240 W. CENTRAL AVENUE		TOLEDO	OH	43617-1119	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #118	1500 E. ALEXIS ROAD		TOLEDO	OH	43612-3952	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #211	10055 OLDE US 20		ROSSFORD	OH	43460-1720	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	10/14/2020	01/01/2021	08/29/2024	09/05/2024
Contract Detail	OHIO CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10457	7510 SYLVANIA AVENUE	SYLVANIA	OH	43560	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	CVS/PHARMACY # 10246	4121 MONROE STREET	TOLEDO	OH	43606	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	CVS/PHARMACY #11155	2104 S. BYRNE ROAD	TOLEDO	OH	43614	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16660	9666 OLDE US 20	ROSSFORD	OH	43460	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	CVS/PHARMACY # 11228	3316 NAVARRE AVE. SUITE E	OREGON	OH	43616	04/08/2024	07/01/2024		07/01/2024
Contract Detail	OHIO CVS STORES, L.L.C.	DBA CVS/PHARMACY #10248	212 E. WOOSTER STREET	BOWLING GREEN	OH	43402	04/08/2024	07/01/2024		07/01/2024
Contract Detail	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16165	5225 MONROE ST	TOLEDO	OH	43623	04/08/2024	07/01/2024		07/01/2024
Contract Detail	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03471	600 E. STATE ST.	FREMONT	OH	43420	04/08/2024	07/01/2024		07/01/2024
Contract Detail	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06181	341 WEST HIGH ST	BRYAN	OH	43506	04/08/2024	07/01/2024		07/01/2024
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	07/18/2016	10/01/2016	08/15/2018	08/15/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	27005 HILLS TECH COURT	FARMINGTON HILLS	MI	48331-5723	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/15/2020	01/01/2021	10/14/2021	10/15/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/19/2022	04/20/2022		04/21/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/13/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	10/15/2021	01/01/2022		01/01/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/15/2021	01/01/2022		01/01/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/13/2020	07/01/2020		07/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/19/2022	07/01/2022		07/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/19/2022	07/01/2022		07/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/19/2022	07/01/2022		07/01/2022
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/08/2024	07/01/2024		07/01/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #6679	105 GOLDEN GATE PLAZA	MAUMEE	OH	43537	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #1092	2450 SOUTH REYNOLDS ROAD	TOLEDO	OH	43614	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #6681	5890 MONROE STREET	SYLVANIA	OH	43560	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #2309	1012 WEST SYLVANIA AVENUE	TOLEDO	OH	43612	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #7817	7504 WEST CENTRAL AVENUE	TOLEDO	OH	43617	01/14/2021	04/01/2021	10/07/2022	02/27/2023
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #6683	3911 SECOR ROAD	TOLEDO	OH	43623	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #7945	3362 NAVARRE AVENUE	OREGON	OH	43616	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #2340	2434 WEST LASKEY ROAD	TOLEDO	OH	43613	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #7728	722-740 SOUTH MAIN STREET	BOWLING GREEN	OH	43402	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/08/2024	07/01/2024		07/01/2024
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/08/2024	07/01/2024		07/01/2024
Contract Detail	THE CLINIC PHARMACY	4235 SECOR RD		TOLEDO	OH	43623-4231	10/14/2020	01/01/2021		01/01/2021
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2316	3325 WEST CENTRAL AVENUE	TOLEDO	OH	43606	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2346	810 EAST MANHATTAN BLVD.	TOLEDO	OH	43608	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2348	1496 NORTH SHOOP AVENUE	WAUSEON	OH	43567	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2355	105 WEST AIRPORT HIGHWAY	SWANTON	OH	43558	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2326	1175 LOUISIANA AVE	PERRYSBURG	OH	43551	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2318	5224 DORR STREET	TOLEDO	OH	43615	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2313	1111 SCOTT STREET	NAPOLEON	OH	43545	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2321	2430 GLENDALE AVENUE	TOLEDO	OH	43614	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2317	3013 MONROE STREET	TOLEDO	OH	43606	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2353	8239 WATERVILLE SWANTON ROAD	WATERVILLE	OH	43566	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2343	7225 AIRPORT HIGHWAY	HOLLAND	OH	43528	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2320	113 NORTH COUNTYLINE STREET	FOSTORIA	OH	44830	01/14/2021	04/01/2021	08/29/2024	09/05/2024
Contract Detail	TOLEDO CLINIC INC	DBA ADVANCED PHARMACY SERVICES	1200 MEDICAL CENTER PKWY STE 1100	MAUMEE	OH	43537	10/14/2020	01/01/2021		01/01/2021
Contract Detail	UNIVERSITY OF TOLEDO	MEDICAL CENTER PHARMACY	2801 W BANCROFT ST	TOLEDO	OH	43606-3328	04/05/2016	07/01/2016		04/05/2016
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08013	1003 N. MAIN ST.	ADRIAN	MI	49221	04/08/2024	07/01/2024		07/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH360048A	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Glendale Medical Center	3355 Glendale Avenue	Toledo	OH	Terminated
DSH360048AA	Child	DSH	UNIV OF TOLEDO MEDL CENTER	OP-Clinic-Recovery Services - RHC Recovery Services	3125 Transverse Dr.	Toledo	OH	Active
DSH360048AB	Child	DSH	UNIV OF TOLEDO MEDL CENTER	CCC PULMONOLOGY CLINIC - CCC PULMONOLOGY	3333 GLENDALE AVE	TOLEDO	OH	Active
DSH360048AC	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Cardiac Rehabilitation - Cardiac Rehabilitation	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AD	Child	DSH	UNIV OF TOLEDO MEDL CENTER	OP Clinic Kidney Transplant - Transplant Clinic	3000 Arlington Ave.	Toledo	OH	Active
DSH360048AE	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Occupational Therapy - Occupational Therapy	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AF	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Radiology-Diagnostic - Radiology-Orthopaedics	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AG	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Physical Therapy - MP Rehab Psychology Svc	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AH	Child	DSH	UNIV OF TOLEDO MEDL CENTER	MP Specialty Clinic - MP Gastroenterology - MP Neurology	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AJ	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RHC Rheumatology - Rheumatology	3125 Transverse Dr.	Toledo	OH	Active
DSH360048AK	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Radiology - Radiology-Ambulatory Sites	1000 Regency Ct.	Toledo	OH	Terminated
DSH360048AL	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Radiology - Radiology-Comprehensive Care Center	3333 Glendale Ave.	Toledo	OH	Active
DSH360048AM	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Radiology - Radiology-Orthopaedics	1125 Hospital Dr.	Toledo	OH	Terminated
DSH360048AN	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Occupational Health - OCC Screening and Exp Clinic	1125 Hospital Dr.	Toledo	OH	Active
DSH360048AP	Child	DSH	UNIV OF TOLEDO MEDL CENTER	OP-Clinic-Allergy - Allergy & Immunology	3125 Transverse Dr.	Toledo	OH	Active
DSH360048AQ	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DANA CANCER CENTER MAUMEE - Oncology	1200 MEDICAL CENTER PKWY	MAUMEE	OH	Active
DSH360048AR	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DANA CANCER CENTER AT HS - Oncology	4126 N HOLLAND SYLVANIA RD	TOLEDO	OH	Active
DSH360048AS	Child	DSH	UNIV OF TOLEDO MEDL CENTER	FALLEN TIMBERS PRIMARY CARE - FAMILY MEDICINE	3100 MAIN ST	MAUMEE	OH	Active
DSH360048AT	Child	DSH	UNIV OF TOLEDO MEDL CENTER	MP - STUDENT HEALTH AND WELLNESS	1125 Hospital Dr	Toledo	OH	Active
DSH360048AU	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RUPPERT HEALTH CENTER - INFECTIOUS DISEASE	3125 TRANSVERSE DR	TOLEDO	OH	Active
DSH360048B	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Comprehensive Care Center / Geriatric Clinic	3333 Glendale Avenue	Toledo	OH	Active
DSH360048C	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Comprehensive Care Center / Family Practice	3333 Glendale Avenue	Toledo	OH	Active
DSH360048D	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Eleanor N. Dana / Cancer Center Clinic	1325 Conference Drive	Toledo	OH	Active
DSH360048E	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Eleanor N. Dana Cancer Center / Dana Infusion Center	1325 Conference Drive	Toledo	OH	Active
DSH360048F	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Eleanor N. Dana Cancer Center / Radiation Therapy-Univ Med Ctr	1325 Conference Drive	Toledo	OH	Active
DSH360048G	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP- PHYSICAL THERAPY	1125 Hospital Dr	TOLEDO	OH	Active
DSH360048H	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP - Clinic - Pain Medicine	1125 HOSPITAL DRIVE	TOLEDO	OH	Active
DSH360048J	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP - Clinic - Parkinson	1125 Hospital Dr	TOLEDO	OH	Terminated
DSH360048K	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Comprehensive Care Clinic - OP-Clinic-Medicine	3333 Glendale Ave.	TOLEDO	OH	Active
DSH360048L	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP-Clinic-Rehab Med	1125 Hospital Dr	TOLEDO	OH	Active
DSH360048M	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP-Clinic-Orthopedic	1125 HOSPITAL DRIVE	TOLEDO	OH	Active
DSH360048N	Child	DSH	UNIV OF TOLEDO MEDL CENTER	HOSPITAL - OP-Clinic-Surgery	3000 Arlington Ave	TOLEDO	OH	Active
DSH360048P	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RUPPERT HEALTH CENTER - OP-Clinic-Psychiatry	3125 Transverse DrIve	TOLEDO	OH	Active
DSH360048Q	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - ENDOSCOPY	1125 Hospital Dr	TOLEDO	OH	Active
DSH360048R	Child	DSH	UNIV OF TOLEDO MEDL CENTER	DOWLING HALL - OP-Clinic-Urology	3000 Arlington Ave.	TOLEDO	OH	Active
DSH360048S	Child	DSH	UNIV OF TOLEDO MEDL CENTER	OP-Clinic-OB/GYN	3125 Transverse Dr.	TOLEDO	OH	Active
DSH360048T	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RUPPERT HEALTH CENTER - OP-Clinic-Pediatrics	3125 Transverse DrIve	TOLEDO	OH	Active
DSH360048U	Child	DSH	UNIV OF TOLEDO MEDL CENTER	Anticoagulation Clinic	3000 Arlington Avenue	TOLEDO	OH	Active
DSH360048V	Child	DSH	UNIV OF TOLEDO MEDL CENTER	CCC SOUTH TOLEDO INTERNISTS - Internal Medicine	3333 Glendale Ave	Toledo	OH	Active
DSH360048W	Child	DSH	UNIV OF TOLEDO MEDL CENTER	UT HEALTH PHYSICAL THERAPY & SPORTS - Regency Rehab	1000 REGENCY CT 105	TOLEDO	OH	Active
DSH360048X	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RHC - UTMC Care Clinic	3125 Transverse Dr.	Toledo	OH	Active
DSH360048Y	Child	DSH	UNIV OF TOLEDO MEDL CENTER	CCC NEPHROLOGY CLINIC - CCC Nephrology	3333 GLENDALE AVE	TOLEDO	OH	Active
DSH360048Z	Child	DSH	UNIV OF TOLEDO MEDL CENTER	RHC Dermatology - RHC Dermatology	3125 Transverse Dr.	Toledo	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 4:07:27 PM	8/29/2024 8:41:16 AM	8/29/2024 8:41 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 8:13:00 AM	8/29/2023 4:07:27 PM	8/29/2023 4:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/26/2023 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1811971302	4/26/2023 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	4/26/2023 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811971302	4/26/2023 1:08 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	4/26/2023 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1457314502	4/26/2023 1:08 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	4/26/2023 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1154384204	4/26/2023 1:08 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	4/26/2023 1:08 PM
Contacts	Authorizing Official	Update	Profile Change Request	Smith, Russell Wayne Chief Pharmacy Officer University of Toledo Medical Center 4193833788	Smith, Russell Wayne Senior Hospital Administrator University of Toledo Medical Center 4193833788	9/7/2022 9:35 AM
Details	Last Recertification Date	Update	Recertification	9/14/2021 2:56:16 PM	9/7/2022 8:13:00 AM	9/7/2022 8:13 AM
Contacts	Authorizing Official	Update	New Registration	Smith, Russell Chief Pharmacy Officer University of Toledo Medical Center 4193833788	Smith, Russell Wayne Chief Pharmacy Officer University of Toledo Medical Center 4193833788	10/15/2021 12:23 PM
Addresses	Shipping Address	Delete	Recertification	University of Toledo Medical Center 3125 Transverse Dr. Suite 1725 Toledo, OH 43614		9/14/2021 2:56 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 12:12:39 PM	9/14/2021 2:56:16 PM	9/14/2021 2:56 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	8/19/2020 12:12 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	8/19/2020 12:12 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	8/19/2020 12:12 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:14:05 PM	8/19/2020 12:12:39 PM	8/19/2020 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1700849858 ( )		1/7/2020 11:31 AM
Addresses	Billing Address	Insert	Change Request		UNIV OF TOLEDO MEDL CENTER 2801 W. BANCROFT ST. TOLEDO, OH 43606	10/30/2019 2:40 PM
Addresses	Shipping Address	Insert	Change Request		University of Toledo Medical Center 3000 Arlington Ave. Toledo, OH 43614	10/24/2019 9:21 AM
Addresses	Shipping Address	Delete	Recertification	University of Toledo Medical Center 3333 Glendale Ave MS 208 Toledo, OH 43614		9/4/2019 2:14 PM
Addresses	Shipping Address	Insert	Recertification		University of Toledo Medical Center 3333 Glendale Ave MS 1208 Toledo, OH 43614	9/4/2019 2:14 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 11:17:41 AM	9/4/2019 2:14:05 PM	9/4/2019 2:14 PM
Contacts	Authorizing Official	Update	OPA Edit	Barbee, Daniel L Chief Exec Officer of UTMC University of Toledo Medical Center 4193836332	Smith, Russell Chief Pharmacy Officer University of Toledo Medical Center 4193833788	8/19/2019 12:41 PM
Contacts	Primary Contact	Update	OPA Edit	Smith, Russell Chief Pharmacy Officer University of Toledo Medical Center 4193833788	Caton, Holiday Robin 340B Specialist The University of Toledo Medical Center 4193833609	8/19/2019 12:41 PM
Contacts	Primary Contact	Update	Profile Change Request	Smith, Russell Director of Pharmacy University of Toledo Medical Center 4193833788	Smith, Russell Chief Pharmacy Officer University of Toledo Medical Center 4193833788	8/19/2019 9:32 AM
Addresses	Shipping Address	Insert	Change Request		University of Toledo Medical Center 3333 Glendale Ave MS 208 Toledo, OH 43614	7/17/2019 8:45 AM
Contacts	Authorizing Official	Update	Change Request	Goedde, Ronald Finance Officer - Hospital UNIV OF TOLEDO MEDL CENTER 4193836376	Barbee, Daniel L Chief Exec Officer of UTMC University of Toledo Medical Center 4193836332	12/28/2018 9:06 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 11:32:42 AM	9/7/2018 11:17:41 AM	9/7/2018 11:17 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/20/2017 11:32:42 AM	11/20/2017 11:32 AM
Contacts	Authorizing Official	Update		Goedde, Ronald Finance Officer - Hospital 4193836376	Goedde, Ronald Finance Officer - Hospital UNIV OF TOLEDO MEDL CENTER 4193836376	9/27/2017 9:31 AM
Contacts	Signed By	Update		Goedde, Ronald Finance Officer - Hospital 4193836376	Goedde, Ronald Finance Officer - Hospital UNIV OF TOLEDO MEDL CENTER 4193836376	9/27/2017 9:31 AM
Contacts	Primary Contact	Update		Smith, Russell Director of Pharmacy 4193833788	Smith, Russell Director of Pharmacy University of Toledo Medical Center 4193833788	9/21/2017 11:46 AM
Addresses	Main Address	Insert			3000 ARLINGTON AVENUE TOLEDO, OH 43614-2589	2/6/2017 10:03 AM
Addresses	Shipping Address	Insert			University of Toledo Medical Center 3125 Transverse Dr. Suite 1725 Toledo, OH 43614	2/6/2017 10:03 AM
Contacts	Authorizing Official	Insert			Goedde, Ronald Finance Officer - Hospital 4193836376	2/6/2017 10:03 AM
Contacts	Signed By	Insert			Goedde, Ronald Finance Officer - Hospital 4193836376	2/6/2017 10:03 AM
Contacts	Primary Contact	Insert			Smith, Russell Director of Pharmacy 4193833788	2/6/2017 10:03 AM
Details	Last Recertification Date	Update			8/18/2016 12:00:00 AM	8/18/2016 12:42 PM
Dates	Participating Approval Date	Update			3/15/2016 12:00:00 AM	3/15/2016 2:44 PM
Details	State	Update		Pending	Active	3/15/2016 2:44 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	3/15/2016 2:44 PM
Details	340B ID	Update		ONLINE_REG_57119	DSH360048	1/12/2016 9:48 AM
Details	340B ID	Update			ONLINE_REG_57119	1/12/2016 8:20 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/12/2016 8:20 AM
Medicaid Billing	Medicaid: Number	Insert			5616506	1/12/2016 8:20 AM
Medicaid Billing	Medicaid: State	Insert			OH	1/12/2016 8:20 AM
Medicaid Billing	NPI: Number	Insert			1811971302	1/12/2016 8:20 AM
Medicaid Billing	NPI: Number	Insert			1700849858	1/12/2016 8:20 AM
Medicaid Billing	NPI: Number	Insert			1457314502	1/12/2016 8:20 AM
Medicaid Billing	NPI: Number	Insert			1154384204	1/12/2016 8:20 AM
Details	Last Recertification Date	Insert				1/12/2016 8:20 AM
Details	Grant Number	Insert				1/12/2016 8:20 AM
Details	340B ID	Insert				1/12/2016 8:20 AM
Details	Is Authorizing Official EHB Data	Insert				1/12/2016 8:20 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/12/2016 8:20 AM
Details	Medicare Provider Number	Insert			360048	1/12/2016 8:20 AM
Details	Entity Name	Insert			UNIV OF TOLEDO MEDL CENTER	1/12/2016 8:20 AM
Details	Program Code	Insert			DSH	1/12/2016 8:20 AM
Details	Entity Subname	Insert				1/12/2016 8:20 AM
Dates	Participating Approval Date	Insert				1/12/2016 8:20 AM
Details	State	Insert			Pending	1/12/2016 8:20 AM
Dates	Registration Date	Insert			1/12/2016 12:00:00 AM	1/12/2016 8:20 AM
Dates	Signed By Date	Insert			1/12/2016 12:00:00 AM	1/12/2016 8:20 AM
Dates	Start Date	Insert				1/12/2016 8:20 AM
Terminations	Termination Comments	Insert				1/12/2016 8:20 AM
Terminations	Termination Date	Insert				1/12/2016 8:20 AM
Terminations	Termination Effective Date	Insert				1/12/2016 8:20 AM
Terminations	Termination Reason	Insert				1/12/2016 8:20 AM