Covered Entity Details

DSH360144A SOUTH POINTE HOSPITAL (Terminated) - information as of 4/30/2025 10:57:26 PM

Main Details

Name

SOUTH POINTE HOSPITAL

Subdivision Name

Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360144A

Medicare Provider Number

360144

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/11/2017

Participating Start Date

7/1/2017

Participating Approval Date

6/8/2017

Last Recertification Date

11/10/2017

Termination Date
Termination Reason

7/1/2018
DSH percentage below statutory minimum

Contacts

Authorizing Official

Cleveland Clinic South Pointe Hospital
Kris Bennett, Chief Operating Officer
(440) 312-2702

Primary Contact

Cleveland Clinic
Jonathan Williams, Senior Director of Pharmacy - 340B
(216) 444-8884

Addresses

Street Address

20050 Harvard Rd.
Suite 326
Warrensville Heights, OH 44122

Billing Address

Cleveland Clinic
6801 Brecksville Road – Suite 20
Mail Code: RK1-25
Independence, OH 44131

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	0063934,8552507
		1194081562,1235183542

Shipping Addresses

Shipping Address 1

South Pointe Hospital Cleveland Clinic Hlth System
4110 Warrensville Center Rd.
Warrensville Hts, OH 44122

Shipping Address 2

South Pointe Hospital
20000 Harvard Rd
Warrensville Hts, OH 44122

Shipping Address 3

Merdia South Pointe Hosp Pointe B
4110 Warrensville Center Rd
Warrensville Hts, OH 44122

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
DSH360144A	Child	DSH	SOUTH POINTE HOSPITAL	Oncology	20050 Harvard Rd.	Warrensville Heights	OH	Terminated
DSH360144B	Child	DSH	SOUTH POINTE HOSPITAL	Heart Failure Clinic	4110 Warrensville Center Road	Warrensville Heights	OH	Terminated
DSH360144C	Child	DSH	SOUTH POINTE HOSPITAL	Internal Medicine Clinic	20050 Harvard Road	Warrensville Heights	OH	Terminated
DSH360144D	Child	DSH	SOUTH POINTE HOSPITAL	Family Practice Clinic	4110 Warrensville Center Rd	Warrensville Heights	OH	Terminated
DSH360144E	Child	DSH	SOUTH POINTE HOSPITAL	South Pointe - Family Medicine - SP PRIMARY CARE CLINIC TECH	4180 WARRENSVILLE CENTER RD	WARRENSVILLE HEIGHTS	OH	Active
DSH360144F	Child	DSH	SOUTH POINTE HOSPITAL	South Pointe - Chronic Care - CHRONIC CARE CLINIC	4180 WARRENSVILLE CENTER RD	Warrensville Heights	OH	Active
DSH360144G	Child	DSH	SOUTH POINTE HOSPITAL	South Pointe - WOUND CENTER - WOUND CENTER	4180 WARRENSVILLE CENTER RD	WARRENSVILLE HEIGHTS	OH	Active
DSH360144H	Child	DSH	SOUTH POINTE HOSPITAL	South Pointe MOB - INTERNAL MEDICINE - RESIDENT CLINIC TECH	4200 Warrensville Center Rd.	WARRENSVILLE HEIGHTS	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Williams, Jonathan Director of Pharmacy - 340B Cleveland Clinic 2164448884	Williams, Jonathan Senior Director of Pharmacy - 340B Cleveland Clinic 2164448884	8/27/2023 3:57 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/18/2018 12:00:00 AM	6/1/2018 6:33 AM
Details	State	Update	Termination Request	Active	To Be Terminated	6/1/2018 6:33 AM
Terminations	Termination Comments	Update	Termination Request		Cost report date listed as 5/18/18. Mailed on 5/21/18.	6/1/2018 6:33 AM
Terminations	Termination Date	Update	Termination Request		7/1/2018 12:00:00 AM	6/1/2018 6:33 AM
Terminations	Termination Effective Date	Update	Termination Request		5/22/2018 12:00:00 AM	6/1/2018 6:33 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	6/1/2018 6:33 AM
Details	Last Recertification Date	Update	Recertification	10/26/2017 11:23:27 AM	11/10/2017 3:21:34 PM	11/10/2017 3:21 PM
Details	Last Recertification Date	Update	Recertification		10/26/2017 11:23:27 AM	10/26/2017 11:23 AM
Contacts	Authorizing Official	Update		Bennett, Kris Chief Operating Officer 4403122702	Bennett, Kris Chief Operating Officer Cleveland Clinic South Pointe Hospital 4403122702	10/19/2017 1:55 PM
Contacts	Signed By	Update		Bennett, Kris Chief Operating Officer 4403122702	Bennett, Kris Chief Operating Officer Cleveland Clinic South Pointe Hospital 4403122702	10/19/2017 1:55 PM
Contacts	Primary Contact	Update		Williams, Jonathan Director of Pharmacy - 340B 2164448884	Williams, Jonathan Director of Pharmacy - 340B Cleveland Clinic 2164448884	10/4/2017 9:08 AM
Contacts	Primary Contact	Insert			Williams, Jonathan Director of Pharmacy - 340B 2164448884	8/9/2017 9:58 AM
Contacts	Authorizing Official	Insert			Bennett, Kris Chief Operating Officer 4403122702	8/2/2017 2:03 PM
Contacts	Signed By	Insert			Bennett, Kris Chief Operating Officer 4403122702	8/2/2017 2:03 PM
Addresses	Main Address	Insert			20050 Harvard Rd. Suite 326 Warrensville Heights, OH 44122	8/2/2017 2:03 PM
Addresses	Billing Address	Insert			Cleveland Clinic 6801 Brecksville Road – Suite 20 Mail Code: RK1-25 Independence, OH 44131	8/2/2017 2:03 PM
Addresses	Shipping Address	Insert			Merdia South Pointe Hosp Pointe B 4110 Warrensville Center Rd Warrensville Hts, OH 44122	8/2/2017 2:03 PM
Addresses	Shipping Address	Insert			South Pointe Hospital Cleveland Clinic Hlth System 4110 Warrensville Center Rd. Warrensville Hts, OH 44122	8/2/2017 2:03 PM
Addresses	Shipping Address	Insert			South Pointe Hospital 20000 Harvard Rd Warrensville Hts, OH 44122	8/2/2017 2:03 PM
Dates	Participating Approval Date	Update			6/8/2017 12:00:00 AM	6/8/2017 3:03 PM
Details	State	Update		Pending	Active	6/8/2017 3:03 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	6/8/2017 3:03 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76464	DSH360144A	4/12/2017 11:21 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76464	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: Number	Insert			0063934	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: State	Insert			OH	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: Number	Insert			8552507	4/11/2017 10:35 AM
Medicaid Billing	Medicaid: State	Insert			OH	4/11/2017 10:35 AM
Medicaid Billing	NPI: Number	Insert			1194081562	4/11/2017 10:35 AM
Medicaid Billing	NPI: Number	Insert			1235183542	4/11/2017 10:35 AM
Details	Last Recertification Date	Insert				4/11/2017 10:35 AM
Details	Grant Number	Insert				4/11/2017 10:35 AM
Details	340B ID	Insert				4/11/2017 10:35 AM
Details	Is Authorizing Official EHB Data	Insert				4/11/2017 10:35 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2017 10:35 AM
Details	Medicare Provider Number	Insert			360144	4/11/2017 10:35 AM
Details	Entity Name	Insert			SOUTH POINTE HOSPITAL	4/11/2017 10:35 AM
Details	Program Code	Insert			DSH	4/11/2017 10:35 AM
Details	Entity Subname	Insert			Oncology	4/11/2017 10:35 AM
Dates	Participating Approval Date	Insert				4/11/2017 10:35 AM
Details	State	Insert			Pending	4/11/2017 10:35 AM
Dates	Registration Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 10:35 AM
Dates	Signed By Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 10:35 AM
Dates	Start Date	Insert				4/11/2017 10:35 AM
Terminations	Termination Comments	Insert				4/11/2017 10:35 AM
Terminations	Termination Date	Insert				4/11/2017 10:35 AM
Terminations	Termination Effective Date	Insert				4/11/2017 10:35 AM
Terminations	Termination Reason	Insert				4/11/2017 10:35 AM