Covered Entity Details

DSH360068G THE TOLEDO HOSPITAL (Active) - information as of 5/17/2025 10:55:10 PM

Main Details

Name

THE TOLEDO HOSPITAL

Subdivision Name

Hickman Cancer Center - Radiation Oncology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360068G

Medicare Provider Number

360068

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/1/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/4/2018

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

ProMedica
Andrew James Hageman, Finance Director
(567) 585-0990

Primary Contact

Promedica Health Systems
Devan Matthew Ribley, Lead 340B Analyst
(567) 585-0154

Addresses

Street Address

5300 Harroun Road
Suite 010
Sylvania, OH 43560

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?
Yes

State	Medicaid Number	NPI Number
OH	8822662,0999675	1407854771,1205837259,1285041004
MI	1555780,5172625	1407854771,1205837259
IN	100036020A	1407854771

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
DSH360068AA	Child	DSH	THE TOLEDO HOSPITAL	PreOp - TFL Surg Pre Op - PreOp	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AB	Child	DSH	THE TOLEDO HOSPITAL	Surgery - TFL Surg PACU - Surgery	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AC	Child	DSH	THE TOLEDO HOSPITAL	Endoscopy - TFL Periop Endoscopy - Endoscopy	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AD	Child	DSH	THE TOLEDO HOSPITAL	PET Scan - TFL PET Imaging - PET Scan	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AE	Child	DSH	THE TOLEDO HOSPITAL	MRI - TFL MR Imaging - MRI	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AF	Child	DSH	THE TOLEDO HOSPITAL	Hemophilia Center - PCJ Hemophilia Center - Hemophilia Center	2109 Hughes Drive	Toledo	OH	Active
DSH360068AG	Child	DSH	THE TOLEDO HOSPITAL	Cardiology Serv Non Invasive - TFL Cardiovascular - Cardiology	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AH	Child	DSH	THE TOLEDO HOSPITAL	Nuclear Medicine - TFL NM Imaging - Nuclear Medicine	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AJ	Child	DSH	THE TOLEDO HOSPITAL	Emergency Center - TFL Emergency Dept - Emergency Center	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AK	Child	DSH	THE TOLEDO HOSPITAL	Radiology - TFL XR Imaging - Radiology	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AL	Child	DSH	THE TOLEDO HOSPITAL	INTERVENTIONAL RAD RECOV IRR - TFL IR RECOVERY - Interventional Rad Recovery	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AM	Child	DSH	THE TOLEDO HOSPITAL	IR - TFL US IMAGING - Interventional Radiology	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AN	Child	DSH	THE TOLEDO HOSPITAL	Cardiology - TFL CARDIAC CATH - Cardiology	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AP	Child	DSH	THE TOLEDO HOSPITAL	Ultrasound - TFL US Imaging - Ultrasound	5200 Harroun Rd	Sylvania	OH	Active
DSH360068AQ	Child	DSH	THE TOLEDO HOSPITAL	Hematology and Oncology Clinic - Hematology/Oncology	5308 HARROUN RD	Sylvania	OH	Approved
DSH360068AR	Child	DSH	THE TOLEDO HOSPITAL	Gynecology Oncology Clinic - Gynecology Oncology	5308 HARROUN RD	Sylvania	OH	Approved
DSH360068AS	Child	DSH	THE TOLEDO HOSPITAL	Pediatric Endocrinology Clinic - Endocrinology	2100 W CENTRAL AVE	Toledo	OH	Approved
DSH360068AT	Child	DSH	THE TOLEDO HOSPITAL	Adult Endocrinology Clinic - Endocrinology	2100 W CENTRAL AVE	Toledo	OH	Approved
DSH360068B	Child	DSH	THE TOLEDO HOSPITAL	CARDIAC TESTING CENTER	2940 N MCCORD RD	TOLEDO	OH	Active
DSH360068C	Child	DSH	THE TOLEDO HOSPITAL	WOMEN'S SERVICES-CHS	2150 WEST CENTRAL AVE	TOLEDO	OH	Active
DSH360068D	Child	DSH	THE TOLEDO HOSPITAL	PARKWAY SURGERY CENTER - Outpatient Surgical Center	2120 W CENTRAL AVE	TOLEDO	OH	Active
DSH360068E	Child	DSH	THE TOLEDO HOSPITAL	Hickman Cancer Center - Medical Physics	5300 Harroun Road	Sylvania	OH	Active
DSH360068F	Child	DSH	THE TOLEDO HOSPITAL	Hickman Cancer Center - Medical Oncology	5300 Harroun Road	Sylvania	OH	Active
DSH360068G	Child	DSH	THE TOLEDO HOSPITAL	Hickman Cancer Center - Radiation Oncology	5300 Harroun Road	Sylvania	OH	Active
DSH360068H	Child	DSH	THE TOLEDO HOSPITAL	Neurosensory Clinic - Neuroscience Center	2130 W. Central Ave	Toledo	OH	Active
DSH360068J	Child	DSH	THE TOLEDO HOSPITAL	ProMedica Cancer Center - Oncology	1620 Brigham Dr	Perrysburg	OH	Active
DSH360068K	Child	DSH	THE TOLEDO HOSPITAL	Peds and Peds Specialty Ambulatory - Pediatric services	2150 West Central Ave	Toledo	OH	Active
DSH360068L	Child	DSH	THE TOLEDO HOSPITAL	PROMEDICA TOLEDO HOSPITAL EMERGENCY - Free Standing ED Department	1075 MEDICAL CENTER PARKWAY	MAUMEE	OH	Active
DSH360068M	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - CHS Jobst MTM	2150 Central Ave	Toledo	OH	Active
DSH360068N	Child	DSH	THE TOLEDO HOSPITAL	Post Anesthesia Care Unit - WWH Periop Surgery	2901 N. Reynolds Rd.	Toledo	OH	Active
DSH360068P	Child	DSH	THE TOLEDO HOSPITAL	Surgery - WWH Surg Intra Op	2901 N. Reynolds Rd.	Toledo	OH	Active
DSH360068Q	Child	DSH	THE TOLEDO HOSPITAL	Heart Failure Clinic - PCJ Heart Failure Clinic	2109 Hughes Dr	Toledo	OH	Active
DSH360068R	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - MFT Jobst MTM	5757 Monclova Rd	Maumee	OH	Active
DSH360068S	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - WLC Jobst MTM	5700 Monroe St	Sylvania	OH	Active
DSH360068T	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - TFL Jobst MTM	5300 Harroun Rd	Sylvania	OH	Active
DSH360068U	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - PPC Jobst MTM	2940 N Mccord Rd	Toledo	OH	Active
DSH360068V	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - TTH Jobst MTM	2109 Hughes Dr	Toledo	OH	Active
DSH360068W	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - DCC Jobst MTM	2100 W Central Ave	Toledo	OH	Active
DSH360068X	Child	DSH	THE TOLEDO HOSPITAL	Jobst Medication Therapy Management - PPE Jobst MTM	1601 Brigham Dr	Perrysburg	OH	Active
DSH360068Y	Child	DSH	THE TOLEDO HOSPITAL	PACU - TFL PERIOP SURGERY - PACU	5200 Harroun Rd	Sylvania	OH	Active
DSH360068Z	Child	DSH	THE TOLEDO HOSPITAL	CT Scan - TFL CT Imaging - CT Scan	5200 Harroun Rd	Sylvania	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 1:25:36 PM	8/30/2024 6:43:27 AM	8/30/2024 6:43 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1013918937 (OH)		5/23/2024 9:11 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1982601456 (OH)		5/23/2024 9:11 AM
Contacts	Authorizing Official	Update	Change Request	Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 5675850257	Hageman, Andrew James Finance Director ProMedica 5675850990	5/14/2024 2:02 PM
Contacts	Primary Contact	Update	PC Change Request	Trimbath, Christopher Director 340B Program ProMedica Health System 5675851760	Ribley, Devan Matthew Lead 340B Analyst Promedica Health Systems 5675850154	1/10/2024 8:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0999675	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1555780	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5172625	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100036020A	8/15/2023 1:25 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	8/15/2023 1:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1407854771	8/15/2023 1:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	8/15/2023 1:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205837259	8/15/2023 1:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	8/15/2023 1:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1407854771	8/15/2023 1:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/15/2023 1:25 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 6:00:49 PM	8/15/2023 1:25:36 PM	8/15/2023 1:25 PM
Contacts	Primary Contact	Update	Profile Change Request	Trimbath, Christopher 340B Program Manager ProMedica Health System 5675851760	Trimbath, Christopher Director 340B Program ProMedica Health System 5675851760	10/7/2022 3:11 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 11:30:27 AM	9/6/2022 6:00:49 PM	9/6/2022 6:00 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 12:41:45 PM	9/10/2021 11:30:27 AM	9/10/2021 11:30 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407854771	9/8/2020 12:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/8/2020 12:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1013918937	9/8/2020 12:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/8/2020 12:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205837259	9/8/2020 12:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/8/2020 12:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285041004	9/8/2020 12:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/8/2020 12:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1982601456	9/8/2020 12:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/8/2020 12:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1407854771 ( )		9/8/2020 12:41 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 2:40:46 PM	9/8/2020 12:41:45 PM	9/8/2020 12:41 PM
Contacts	Authorizing Official	Update	Profile Change Request	Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 4192915909	Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 5675850257	9/3/2020 1:25 PM
Contacts	Signed By	Update	Profile Change Request	Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 4192915909	Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 5675850257	9/3/2020 1:25 PM
Details	Last Recertification Date	Update	Recertification		8/28/2019 2:40:46 PM	8/28/2019 2:40 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Addresses	Main Address	Insert	New Registration		5300 Harroun Road Suite 010 Sylvania, OH 43560	10/4/2018 1:19 PM
Contacts	Signed By	Insert	New Registration		Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 4192915909	10/4/2018 1:19 PM
Details	340B ID	Update	New Registration		DSH360068G	10/4/2018 1:19 PM
Details	Entity Subname	Update	New Registration	Hickman Cancer Center	Hickman Cancer Center - Radiation Oncology	10/4/2018 1:19 PM
Dates	Participating Approval Date	Update	New Registration		10/4/2018 1:19:08 PM	10/4/2018 1:19 PM
Details	State	Update	New Registration	Pending	Approved	10/4/2018 1:19 PM
Dates	Signed By Date	Update	New Registration		10/4/2018 11:05:09 AM	10/4/2018 1:19 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/4/2018 1:19 PM
Addresses	Main Address	Insert	New Registration		5300 Harroun Road Suite 010 Sylvania, OH 43560	10/1/2018 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/1/2018 3:04 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		8822662	10/1/2018 3:04 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/1/2018 3:04 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1407854771	10/1/2018 3:04 PM
Contacts	Primary Contact	Insert	New Registration		Trimbath, Christopher 340B Program Manager ProMedica Health System 5675851760	10/1/2018 3:04 PM
Contacts	Authorizing Official	Insert	New Registration		Brewer, David Administrative Director - Metro Acute Care Finance Promedica Health System 4192915909	10/1/2018 3:04 PM
Details	Last Recertification Date	Insert	New Registration			10/1/2018 3:04 PM
Details	Grant Number	Insert	New Registration			10/1/2018 3:04 PM
Details	340B ID	Insert	New Registration			10/1/2018 3:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/1/2018 3:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/1/2018 3:04 PM
Details	Medicare Provider Number	Insert	New Registration		360068	10/1/2018 3:04 PM
Details	Entity Name	Insert	New Registration		THE TOLEDO HOSPITAL	10/1/2018 3:04 PM
Details	Program Code	Insert	New Registration		DSH	10/1/2018 3:04 PM
Details	Entity Subname	Insert	New Registration		Hickman Cancer Center	10/1/2018 3:04 PM
Dates	Participating Approval Date	Insert	New Registration			10/1/2018 3:04 PM
Details	State	Insert	New Registration		Pending	10/1/2018 3:04 PM
Dates	Registration Date	Insert	New Registration		10/1/2018 3:04:34 PM	10/1/2018 3:04 PM
Dates	Signed By Date	Insert	New Registration			10/1/2018 3:04 PM
Dates	Start Date	Insert	New Registration			10/1/2018 3:04 PM
Terminations	Termination Comments	Insert	New Registration			10/1/2018 3:04 PM
Terminations	Termination Date	Insert	New Registration			10/1/2018 3:04 PM
Terminations	Termination Effective Date	Insert	New Registration			10/1/2018 3:04 PM
Terminations	Termination Reason	Insert	New Registration			10/1/2018 3:04 PM