Covered Entity Details

DSH360211C TRINITY HOSPITAL HOLDING COMPANY (Active) - information as of 5/3/2025 11:28:51 PM

Main Details

Name

TRINITY HOSPITAL HOLDING COMPANY

Subdivision Name

Trinity Endoscopy Center - Endoscopy Services

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360211C

Medicare Provider Number

360211

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2022

Participating Start Date

1/1/2023

Participating Approval Date

12/12/2022

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Trinity Health System
Dave Werkin, CFO
(740) 264-8695

Primary Contact

Trinity Health System
Jennifer Davis, System Director of Pharmacy
(740) 264-8663

Addresses

Street Address

1805 Sinclair Ave
Steubenville, OH 43952

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date; (10/01/2018) until terminated effective date: (1/1/2019); reinstatement date: (01/01/2023)	12/12/2022

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	0240386	1285715144
WV	0001071000	1285715144
PA	1009879440001	1285715144

Shipping Addresses

Shipping Address 1

Trinity West - Endoscopy Center
4000 Johnson Rd
Steubenville, OH 43952

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
DSH360211A	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	Cancer Center - Oncology	3204 Johnson Road	Steubenville	OH	Active
DSH360211B	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY EXPRESS CARE - URGENT CARE CENTER	150 MAIN ST	WINTERSVILLE	OH	Active
DSH360211C	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	Trinity Endoscopy Center - Endoscopy Services	1805 Sinclair Ave	Steubenville	OH	Active
DSH360211D	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	CADIZ EXPRESS CARE - Trinity Express Clinic - Cadiz	82424 CADIZ JEWETT RD	CADIZ	OH	Active
DSH360211E	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY MEDICAL CENTER EAST - Psychiatry	380 SUMMIT AVE	STEUBENVILLE	OH	Active
DSH360211F	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY MEDICAL CENTER EAST - Workcare	380 SUMMIT AVE	STEUBENVILLE	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 1:14:58 PM	8/15/2024 6:32:44 AM	8/15/2024 6:32 AM
Details	Last Recertification Date	Update	Recertification		8/28/2023 1:14:58 PM	8/28/2023 1:14 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1285715144	12/12/2022 1:55 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		WV	12/12/2022 1:55 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1285715144	12/12/2022 1:55 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		OH	12/12/2022 1:55 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1285715144	12/12/2022 1:55 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		PA	12/12/2022 1:55 PM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1285715144 ( )		12/12/2022 1:55 PM
Contacts	Primary Contact	Update	Reinstatement	Blake, Jefferey R Director, Pharmacy Services Trinity Hospital Holding Company 7402648669	Davis, Jennifer System Director of Pharmacy Trinity Health System 7402648663	12/12/2022 1:55 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	12/7/2018 12:00:00 AM		12/12/2022 1:55 PM
Dates	Participating Approval Date	Update	Reinstatement	7/31/2018 2:19:43 PM	12/12/2022 1:55:04 PM	12/12/2022 1:55 PM
Details	State	Update	Reinstatement	Terminated	Approved	12/12/2022 1:55 PM
Dates	Registration Date	Update	Reinstatement	7/6/2018 3:27:49 PM	10/13/2022 12:57:37 PM	12/12/2022 1:55 PM
Dates	Signed By Date	Update	Reinstatement	7/9/2018 4:55:33 AM	12/9/2022 4:34:13 PM	12/12/2022 1:55 PM
Dates	Start Date	Update	Reinstatement	10/1/2018 12:00:00 AM	1/1/2023 12:00:00 AM	12/12/2022 1:55 PM
Terminations	Termination Date	Update	Reinstatement	1/1/2019 12:00:00 AM		12/12/2022 1:55 PM
Terminations	Termination Effective Date	Update	Reinstatement	11/29/2018 12:00:00 AM		12/12/2022 1:55 PM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		12/12/2022 1:55 PM
Details	Comments Public	Insert	Reinstatement		Participating from effective date; (10/01/2018) until terminated effective date: (1/1/2019); reinstatement date: (01/01/2023)	12/12/2022 7:27 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/7/2018 12:00:00 AM	12/7/2018 3:47 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/7/2018 3:47 PM
Terminations	Termination Date	Update	Termination Request		1/1/2019 12:00:00 AM	12/7/2018 3:47 PM
Terminations	Termination Effective Date	Update	Termination Request		11/29/2018 12:00:00 AM	12/7/2018 3:47 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/7/2018 3:47 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Werkin, Dave CFO Trinity Health System 7402648695	7/31/2018 2:19 PM
Details	340B ID	Update	New Registration		DSH360211C	7/31/2018 2:19 PM
Details	Entity Subname	Update	New Registration	Trinity Endoscopy Center	Trinity Endoscopy Center - Endoscopy Services	7/31/2018 2:19 PM
Dates	Participating Approval Date	Update	New Registration		7/31/2018 2:19:43 PM	7/31/2018 2:19 PM
Details	State	Update	New Registration	Pending	Approved	7/31/2018 2:19 PM
Dates	Signed By Date	Update	New Registration		7/9/2018 4:55:33 AM	7/31/2018 2:19 PM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	7/31/2018 2:19 PM
Addresses	Main Address	Insert	New Registration		1805 Sinclair Ave Steubenville, OH 43952	7/6/2018 3:27 PM
Addresses	Shipping Address	Insert	New Registration		Trinity West - Endoscopy Center 4000 Johnson Rd Steubenville, OH 43952	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0240386	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001071000	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1009879440001	7/6/2018 3:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/6/2018 3:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285715144	7/6/2018 3:27 PM
Contacts	Primary Contact	Insert	New Registration		Blake, Jefferey R Director, Pharmacy Services Trinity Hospital Holding Company 7402648669	7/6/2018 3:27 PM
Contacts	Authorizing Official	Insert	New Registration		Werkin, Dave CFO Trinity Health System 7402648695	7/6/2018 3:27 PM
Details	Last Recertification Date	Insert	New Registration			7/6/2018 3:27 PM
Details	Grant Number	Insert	New Registration			7/6/2018 3:27 PM
Details	340B ID	Insert	New Registration			7/6/2018 3:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/6/2018 3:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/6/2018 3:27 PM
Details	Medicare Provider Number	Insert	New Registration		360211	7/6/2018 3:27 PM
Details	Entity Name	Insert	New Registration		TRINITY HOSPITAL HOLDING COMPANY	7/6/2018 3:27 PM
Details	Program Code	Insert	New Registration		DSH	7/6/2018 3:27 PM
Details	Entity Subname	Insert	New Registration		Trinity Endoscopy Center	7/6/2018 3:27 PM
Dates	Participating Approval Date	Insert	New Registration			7/6/2018 3:27 PM
Details	State	Insert	New Registration		Pending	7/6/2018 3:27 PM
Dates	Registration Date	Insert	New Registration		7/6/2018 3:27:49 PM	7/6/2018 3:27 PM
Dates	Signed By Date	Insert	New Registration			7/6/2018 3:27 PM
Dates	Start Date	Insert	New Registration			7/6/2018 3:27 PM
Terminations	Termination Comments	Insert	New Registration			7/6/2018 3:27 PM
Terminations	Termination Date	Insert	New Registration			7/6/2018 3:27 PM
Terminations	Termination Effective Date	Insert	New Registration			7/6/2018 3:27 PM
Terminations	Termination Reason	Insert	New Registration			7/6/2018 3:27 PM