Covered Entity Details

DSH360153E BELMONT COMMUNITY HOSPITAL (Terminated) - information as of 4/29/2025 1:37:49 AM

Main Details

Name

BELMONT COMMUNITY HOSPITAL

Subdivision Name

Colerain Health Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360153E

Medicare Provider Number

360153

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/17/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/1/2016

Last Recertification Date

8/16/2018

Termination Date
Termination Reason

4/1/2019
Loss of qualifying hospital status

Contacts

Authorizing Official

Harrison Community Hospital
James Murdy, CFO
(304) 243-3681

Primary Contact

Belmont Community Hospital
James B. Murdy, Chief Financial Officer
(304) 243-3681

Addresses

Street Address

72562 U.S. 250
Colerain, OH 43916

Billing Address
Same as Street Address

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?
No

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
DSH360153A	Child	DSH	BELMONT COMMUNITY HOSPITAL	BELMONT COMMUNITY HEALTH CENTER	3000 GUERNSEY STREET	BELLAIRE	OH	Terminated
DSH360153B	Child	DSH	BELMONT COMMUNITY HOSPITAL	ST. CLAIRSVILLE HEALTH CENTER	51339 NATIONAL ROAD EAST	ST. CLAIRSVILLE	OH	Terminated
DSH360153C	Child	DSH	BELMONT COMMUNITY HOSPITAL	POWHATAN HEALTH CENTER	63 OHIO 7 SOUTH	POWHATAN POINT	OH	Terminated
DSH360153D	Child	DSH	BELMONT COMMUNITY HOSPITAL	Shadyside Health Center	4000 Central Avenue	Shadyside	OH	Terminated
DSH360153E	Child	DSH	BELMONT COMMUNITY HOSPITAL	Colerain Health Center	72562 U.S. 250	Colerain	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/13/2019 12:00:00 AM	1/11/2019 1:17 PM
Details	State	Update	Termination Request	Active	To Be Terminated	1/11/2019 1:17 PM
Terminations	Termination Comments	Update	Termination Request		Belmont Community Hospital has closed a unit that will make the hospital ineligible for 340B	1/11/2019 1:17 PM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/11/2019 1:17 PM
Terminations	Termination Effective Date	Update	Termination Request		1/13/2019 12:00:00 AM	1/11/2019 1:17 PM
Terminations	Termination Reason	Update	Termination Request		Loss of qualifying hospital status	1/11/2019 1:17 PM
Details	Last Recertification Date	Update	Recertification	11/24/2017 9:01:31 AM	8/16/2018 8:38:44 AM	8/16/2018 8:38 AM
Details	Last Recertification Date	Update	Recertification		11/24/2017 9:01:31 AM	11/24/2017 9:01 AM
Contacts	Primary Contact	Update	Recertification	Murdy, James B. Chief Financial Officer 3042433681	Murdy, James B. Chief Financial Officer Belmont Community Hospital 3042433681	11/24/2017 9:01 AM
Contacts	Signed By	Update	Recertification	Murdy, James B. Chief Financial Officer 3042433681	Murdy, James B. Chief Financial Officer Belmont Community Hospital 3042433681	11/24/2017 9:01 AM
Contacts	Authorizing Official	Insert	AO Change Request		Murdy, James CFO Harrison Community Hospital 3042433681	11/20/2017 11:06 AM
Contacts	Primary Contact	Insert			Murdy, James B. Chief Financial Officer 3042433681	8/2/2017 2:06 PM
Contacts	Signed By	Insert			Murdy, James B. Chief Financial Officer 3042433681	8/2/2017 2:06 PM
Addresses	Main Address	Insert			72562 U.S. 250 Colerain, OH 43916	11/1/2016 2:05 PM
Dates	Participating Approval Date	Update			11/1/2016 12:00:00 AM	11/1/2016 2:05 PM
Details	State	Update		Pending	Active	11/1/2016 2:05 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/1/2016 2:05 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73418	DSH360153E	11/1/2016 11:22 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73418	10/17/2016 10:51 AM
Details	Last Recertification Date	Insert				10/17/2016 10:51 AM
Details	Grant Number	Insert				10/17/2016 10:51 AM
Details	340B ID	Insert				10/17/2016 10:51 AM
Details	Is Authorizing Official EHB Data	Insert				10/17/2016 10:51 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/17/2016 10:51 AM
Details	Medicare Provider Number	Insert			360153	10/17/2016 10:51 AM
Details	Entity Name	Insert			BELMONT COMMUNITY HOSPITAL	10/17/2016 10:51 AM
Details	Program Code	Insert			DSH	10/17/2016 10:51 AM
Details	Entity Subname	Insert			Colerain Health Center	10/17/2016 10:51 AM
Dates	Participating Approval Date	Insert				10/17/2016 10:51 AM
Details	State	Insert			Pending	10/17/2016 10:51 AM
Dates	Registration Date	Insert			10/17/2016 12:00:00 AM	10/17/2016 10:51 AM
Dates	Signed By Date	Insert			10/17/2016 12:00:00 AM	10/17/2016 10:51 AM
Dates	Start Date	Insert				10/17/2016 10:51 AM
Terminations	Termination Comments	Insert				10/17/2016 10:51 AM
Terminations	Termination Date	Insert				10/17/2016 10:51 AM
Terminations	Termination Effective Date	Insert				10/17/2016 10:51 AM
Terminations	Termination Reason	Insert				10/17/2016 10:51 AM