Covered Entity Details

DSH360066Q ST. RITAS MEDICAL CENTER LLC (Terminated) - information as of 5/13/2025 10:48:29 PM

Main Details

Name

ST. RITAS MEDICAL CENTER LLC

Subdivision Name

Mercy Health - Westside IV Therapy - IV THERAPY

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360066Q

Medicare Provider Number

360066

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/12/2019

Participating Start Date

10/1/2019

Participating Approval Date

8/8/2019

Last Recertification Date

9/3/2020

Termination Date
Termination Reason

7/26/2021
Change of hospital entity type

Contacts

Authorizing Official

Mercy Health - St. Rita’s
TIM RIEGER, Regional CFO & VP of Finance
(419) 226-9775

Primary Contact

Mercy Health - St. Rita's
Lisa Brady, Director of Pharmacy
(419) 996-5526

Addresses

Street Address

2195 ALLENTOWN RD
LIMA, OH 45805

Billing Address

St. Rita's Medical Center LLC
730 W MARKET ST
LIMA, OH 45801

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	7649503	1811939887

Shipping Addresses

Shipping Address 1

St. Rita's Medical Center LLC
730 W MARKET ST
LIMA, OH 45801

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
DSH360066A	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Imaging and Lab Services - CT	1800 East Fifth St	DELPHOS	OH	Terminated
DSH360066B	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County Radiology - RADIOLOGY	601 STATE ROUTE 224	OTTAWA	OH	Terminated
DSH360066C	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Wound and Ostomy Care - WOUND CARE	830 W HIGH ST	LIMA	OH	Terminated
DSH360066D	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Celina Medical Oncology - Oncology	900 Havermann Road	CELINA	OH	Terminated
DSH360066E	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Rehabilitation and Therapy - Physical Therapy	1800 East Fifth St.	DELPHOS	OH	Terminated
DSH360066F	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Urgent Care - Urgent Care	1800 East Fifth St.	DELPHOS	OH	Terminated
DSH360066G	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County CT - CT	601 STATE ROUTE 224	OTTAWA	OH	Terminated
DSH360066H	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County Outpatient Services - OUTPATIENT SERVICES	601 STATE ROUTE 224	OTTAWA	OH	Terminated
DSH360066J	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Eastside Urgent Care - URGENT CARE	967 BELLEFONTAINE AVE	LIMA	OH	Terminated
DSH360066K	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Westside Urgent Care - URGENT CARE	2195 ALLENTOWN RD	LIMA	OH	Terminated
DSH360066L	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County MRI - MRI	601 STATE ROUTE 224	OTTAWA	OH	Terminated
DSH360066M	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Surgery Center - SURGERY	770 W HIGH ST	LIMA	OH	Terminated
DSH360066N	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Cancer Center - ONCOLOGY	803 W MARKET ST	LIMA	OH	Terminated
DSH360066P	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Allison Radiaton Oncology - Oncology	803 W MARKET ST	LIMA	OH	Terminated
DSH360066Q	Child	DSH	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Westside IV Therapy - IV THERAPY	2195 ALLENTOWN RD	LIMA	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	7/26/2021 12:00:00 AM	7/26/2021 2:45 PM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	7/26/2021 2:45 PM
Terminations	Termination Comments	Update	OPA Edit Termination Info		COVID-19 related CE immediate start date given, 7/26/2021, to RRC360066	7/26/2021 2:45 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	7/26/2021 12:00:00 AM	7/26/2021 2:45 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	7/26/2021 12:00:00 AM	7/26/2021 2:45 PM
Terminations	Termination Reason	Update	OPA Edit Termination Info	Change of covered entity type	Change of hospital entity type	7/26/2021 2:45 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	7/22/2021 10:31 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	7/22/2021 10:31 AM
Terminations	Termination Date	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	7/22/2021 10:31 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	7/22/2021 10:31 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	7/22/2021 10:31 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1811939887 ( )		9/3/2020 3:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1811939887	9/3/2020 3:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 3:49 PM
Details	Last Recertification Date	Update	Recertification		9/3/2020 3:49:38 PM	9/3/2020 3:49 PM
Contacts	Primary Contact	Update	Change Request	Baluh, Kyle 340B Program Manager Bon Secours Mercy Health 4402139813	Brady, Lisa Director of Pharmacy Mercy Health - St. Rita's 4199965526	1/31/2020 7:11 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		RIEGER, TIM Regional CFO & VP of Finance Mercy Health - St. Rita’s 4192269775	8/8/2019 11:19 AM
Details	340B ID	Update	New Registration		DSH360066Q	8/8/2019 11:19 AM
Details	Entity Subname	Update	New Registration	Mercy Health - Westside IV Therapy	Mercy Health - Westside IV Therapy - IV THERAPY	8/8/2019 11:19 AM
Dates	Participating Approval Date	Update	New Registration		8/8/2019 11:19:52 AM	8/8/2019 11:19 AM
Details	State	Update	New Registration	Pending	Approved	8/8/2019 11:19 AM
Dates	Signed By Date	Update	New Registration		8/7/2019 4:48:50 PM	8/8/2019 11:19 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	8/8/2019 11:19 AM
Addresses	Main Address	Insert	New Registration		2195 ALLENTOWN RD LIMA, OH 45805	7/12/2019 11:27 AM
Addresses	Billing Address	Insert	New Registration		St. Rita's Medical Center LLC 730 W MARKET ST LIMA, OH 45801	7/12/2019 11:27 AM
Addresses	Shipping Address	Insert	New Registration		St. Rita's Medical Center LLC 730 W MARKET ST LIMA, OH 45801	7/12/2019 11:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2019 11:27 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7649503	7/12/2019 11:27 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	7/12/2019 11:27 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1811939887	7/12/2019 11:27 AM
Contacts	Primary Contact	Insert	New Registration		Baluh, Kyle 340B Program Manager Bon Secours Mercy Health 4402139813	7/12/2019 11:27 AM
Contacts	Authorizing Official	Insert	New Registration		RIEGER, TIM Regional CFO & VP of Finance Mercy Health - St. Rita’s 4192269775	7/12/2019 11:27 AM
Details	Last Recertification Date	Insert	New Registration			7/12/2019 11:27 AM
Details	Grant Number	Insert	New Registration			7/12/2019 11:27 AM
Details	340B ID	Insert	New Registration			7/12/2019 11:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2019 11:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2019 11:27 AM
Details	Medicare Provider Number	Insert	New Registration		360066	7/12/2019 11:27 AM
Details	Entity Name	Insert	New Registration		ST. RITAS MEDICAL CENTER LLC	7/12/2019 11:27 AM
Details	Program Code	Insert	New Registration		DSH	7/12/2019 11:27 AM
Details	Entity Subname	Insert	New Registration		Mercy Health - Westside IV Therapy	7/12/2019 11:27 AM
Dates	Participating Approval Date	Insert	New Registration			7/12/2019 11:27 AM
Details	State	Insert	New Registration		Pending	7/12/2019 11:27 AM
Dates	Registration Date	Insert	New Registration		7/12/2019 11:27:02 AM	7/12/2019 11:27 AM
Dates	Signed By Date	Insert	New Registration			7/12/2019 11:27 AM
Dates	Start Date	Insert	New Registration			7/12/2019 11:27 AM
Terminations	Termination Comments	Insert	New Registration			7/12/2019 11:27 AM
Terminations	Termination Date	Insert	New Registration			7/12/2019 11:27 AM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2019 11:27 AM
Terminations	Termination Reason	Insert	New Registration			7/12/2019 11:27 AM