Covered Entity Details

DSH360048H UNIV OF TOLEDO MEDL CENTER (Active) - information as of 4/25/2025 6:33:58 PM

Main Details

Name

UNIV OF TOLEDO MEDL CENTER

Subdivision Name

DOWLING HALL - OP - Clinic - Pain Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360048H

Medicare Provider Number

360048

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2018

Participating Start Date

10/1/2018

Participating Approval Date

7/31/2018

Last Recertification Date

9/5/2024

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

1125 HOSPITAL DRIVE
TOLEDO, OH 43614

Billing Address

UNIV OF TOLEDO MEDL CENTER
2801 W. BANCROFT STREET
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
OH	5616506	1811971302,1457314502
MI	1811971302	1811971302,1457314502

Shipping Addresses

Shipping Address 1

UNIV OF TOLEDO MEDL CENTER
3000 ARLINGTON AVE.
TOLEDO, OH 43614

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
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
Addresses	Billing Address	Update	Change Request	UNIV OF TOLEDO MEDL CENTER 3000 ARLINGTON AVE TOLEDO, OH 43614	UNIV OF TOLEDO MEDL CENTER 2801 W. BANCROFT STREET TOLEDO, OH 43606	10/31/2024 12:41 PM
Addresses	Shipping Address	Insert	Change Request		UNIV OF TOLEDO MEDL CENTER 3000 ARLINGTON AVE. TOLEDO, OH 43614	10/31/2024 12:41 PM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:20:12 PM	9/5/2024 10:40:39 AM	9/5/2024 10:40 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1457314502	8/29/2023 2:20 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/29/2023 2:20 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1457314502	8/29/2023 2:20 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	8/29/2023 2:20 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 8:29:44 AM	8/29/2023 2:20:12 PM	8/29/2023 2:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/26/2023 1:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1811971302	4/26/2023 1:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	4/26/2023 1:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811971302	4/26/2023 1:09 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	4/26/2023 1:09 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	9/9/2021 11:24:39 AM	9/7/2022 8:29:44 AM	9/7/2022 8:29 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
Details	Last Recertification Date	Update	Recertification	8/27/2020 11:12:16 AM	9/9/2021 11:24:39 AM	9/9/2021 11:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/27/2020 11:12 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5616506	8/27/2020 11:12 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	8/27/2020 11:12 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	8/27/2020 11:12 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:17:56 PM	8/27/2020 11:12:16 AM	8/27/2020 11:12 AM
Contacts	Primary Contact	Update	Recertification	Smith, Russell Chief Pharmacy Officer University of Toledo Medical Center 4193833788	Caton, Holiday Robin 340B Specialist The University of Toledo Medical Center 4193833609	9/4/2019 2:17 PM
Details	Last Recertification Date	Update	Recertification		9/4/2019 2:17:56 PM	9/4/2019 2:17 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	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
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	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Goedde, Ronald Finance Officer - Hospital UNIV OF TOLEDO MEDL CENTER 4193836376	7/31/2018 8:26 AM
Details	340B ID	Update	New Registration		DSH360048H	7/31/2018 8:26 AM
Details	Entity Subname	Update	New Registration	DOWLING HALL	DOWLING HALL - OP - Clinic - Pain Medicine	7/31/2018 8:26 AM
Dates	Participating Approval Date	Update	New Registration		7/31/2018 8:26:49 AM	7/31/2018 8:26 AM
Details	State	Update	New Registration	Pending	Approved	7/31/2018 8:26 AM
Dates	Signed By Date	Update	New Registration		7/13/2018 1:54:35 PM	7/31/2018 8:26 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	7/31/2018 8:26 AM
Addresses	Main Address	Insert	New Registration		1125 HOSPITAL DRIVE TOLEDO, OH 43614	7/13/2018 11:38 AM
Addresses	Billing Address	Insert	New Registration		UNIV OF TOLEDO MEDL CENTER 3000 ARLINGTON AVE TOLEDO, OH 43614	7/13/2018 11:38 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1811971302	7/13/2018 11:38 AM
Contacts	Authorizing Official	Insert	New Registration		Goedde, Ronald Finance Officer - Hospital UNIV OF TOLEDO MEDL CENTER 4193836376	7/13/2018 11:38 AM
Contacts	Primary Contact	Insert	New Registration		Smith, Russell Director of Pharmacy University of Toledo Medical Center 4193833788	7/13/2018 11:38 AM
Details	Last Recertification Date	Insert	New Registration			7/13/2018 11:38 AM
Details	Grant Number	Insert	New Registration			7/13/2018 11:38 AM
Details	340B ID	Insert	New Registration			7/13/2018 11:38 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2018 11:38 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2018 11:38 AM
Details	Medicare Provider Number	Insert	New Registration		360048	7/13/2018 11:38 AM
Details	Entity Name	Insert	New Registration		UNIV OF TOLEDO MEDL CENTER	7/13/2018 11:38 AM
Details	Program Code	Insert	New Registration		DSH	7/13/2018 11:38 AM
Details	Entity Subname	Insert	New Registration		DOWLING HALL	7/13/2018 11:38 AM
Dates	Participating Approval Date	Insert	New Registration			7/13/2018 11:38 AM
Details	State	Insert	New Registration		Pending	7/13/2018 11:38 AM
Dates	Registration Date	Insert	New Registration		7/13/2018 11:38:13 AM	7/13/2018 11:38 AM
Dates	Signed By Date	Insert	New Registration			7/13/2018 11:38 AM
Dates	Start Date	Insert	New Registration			7/13/2018 11:38 AM
Terminations	Termination Comments	Insert	New Registration			7/13/2018 11:38 AM
Terminations	Termination Date	Insert	New Registration			7/13/2018 11:38 AM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2018 11:38 AM
Terminations	Termination Reason	Insert	New Registration			7/13/2018 11:38 AM