Addresses | Shipping Address | Update | Change Request | The MetroHealth System DBA MetroHealth Broadway Pharmacy
6835 Broadway Ave
2167
Cleveland, OH 44105-1313 | The MetroHealth System DBA MetroHealth Broadway Pharmacy
6835 Broadway Ave
Cleveland, OH 44105-1313 | 4/10/2025 10:02 AM |
Addresses | Shipping Address | Delete | Recertification | The MetroHealth System DBA MetroHealth Beachwood Phcy
3609 Park East Dr
Beachwood, OH 44122-4309 | | 2/25/2025 10:15 AM |
Addresses | Shipping Address | Insert | Recertification | | The MetroHealth System DBA MetroHealth Beachwood Phcy
3609 Park East Dr
1st Floor
Beachwood, OH 44122-4309 | 2/25/2025 10:15 AM |
Details | Last Recertification Date | Update | Recertification | 2/19/2024 11:20:17 AM | 2/25/2025 10:15:46 AM | 2/25/2025 10:15 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Broadway Pharmacy
6835 Broadway Ave
2167
Cleveland, OH 44105-1313 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Cleveland Heights Pharmacy
10 Severance Circle
Cleveland Heights, OH 44118-1533 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | MetroHealth System DBA MetroHealth Plaza Pharmacy
2500 MetroHealth Dr
Cleveland, OH 44109-1900 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Old Brooklyn Pharmacy
4229 Pearl Rd SM2-80
Cleveland, OH 44109-4218 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Parma Pharmacy
12301 Snow Road
Parma, OH 44130-1002 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth Stystem DBA MetroHealth Brecksville Pharmacy
9200 Treeworth Blvd
Brecksville, OH 44141-2591 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Buckeye Health Center
2816 E 116th ST
Cleveland, OH 44120-2111 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Middleburg Hts Pharmacy
7800 Pearl Rd
Middleburg Hts, OH 44130-6552 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | TheMetroHealth System DBA MetroHealth Ohio City Phcy
4757 Lorain Ave
Cleveland, OH 44102-3442 | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Beachwood Phcy
3609 Park East Dr
Beachwood, OH 44122-4309 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 2154636 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 2310609 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 2796792 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0102983 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0112018 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0429409 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0079638 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0444643 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0181115 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0112033 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0175949 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0175941 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 0164524 | 1/29/2025 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1609818681 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1750329264 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1942493663 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1427478858 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1821497306 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1871180026 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1992529911 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1770164592 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1518410869 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1043619604 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1063873297 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1225499775 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1053772715 | 1/29/2025 12:57 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | OH | 1/29/2025 12:57 PM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA Buckeye Health Center Pharmacy
2816 E 116th St
Cleveland, OH 44120-2111 | 12/4/2024 11:18 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA Bedford Health Center Pharmacy
19999 Rockside Rd
Bedford, OH 44146-2074 | 12/4/2024 11:18 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Brooklyn Pharmacy
5208 Memphis Ave
Cleveland, OH 44144 | 12/4/2024 7:37 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System DBA MetroHealth Central Fill/Mail Order/Specialty Pharmacy
9885 Rockside Rd
Ste 157
Valley View, OH 44125-6272 | 12/3/2024 8:13 AM |
Addresses | Billing Address | Insert | Change Request | | The MetroHealth System
2500 Metrohealth Drive
Cleveland, OH 44109-1900 | 10/11/2024 11:05 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System Glenville Community Health Center
11100 Saint Clair Ave
Cleveland, OH 44108-1943 | 10/11/2024 11:05 AM |
Addresses | Shipping Address | Insert | Change Request | | The MetroHealth System FQHCLAL Storeroom
2500 Metrohealth Drive
RM 2205
Cleveland, OH 44109-1900 | 10/11/2024 11:05 AM |
Details | Last Recertification Date | Update | Recertification | 2/14/2023 8:57:58 PM | 2/19/2024 11:20:17 AM | 2/19/2024 11:20 AM |
Contacts | Primary Contact | Update | Profile Change Request | Campitelli, Angela
340B Pharmacy Manager
The MetroHealth System
3303277871 | Campitelli, Angela
Director 340B Program
The MetroHealth System
2167785008 | 9/27/2023 3:55 PM |
Details | Last Recertification Date | Update | Recertification | 2/24/2022 3:58:25 PM | 2/14/2023 8:57:58 PM | 2/14/2023 8:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/24/2022 3:58 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 0443356 | 2/24/2022 3:58 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | OH | 2/24/2022 3:58 PM |
Details | Last Recertification Date | Update | Recertification | 2/2/2021 9:18:07 PM | 2/24/2022 3:58:25 PM | 2/24/2022 3:58 PM |
Contacts | Authorizing Official | Update | Change Request | Jacono, Julie
Chief Strategy Officer
MetroHealth Community Health Center
2163102711 | Nagel, Katherine F
Chief Executive Officer, MetroHealth Community Health Centers
MetroHealth Community Health Centers / The MetroHealth System
2169658562 | 1/27/2022 9:55 AM |
Contacts | Primary Contact | Update | Change Request | Nagel, Katherine F
Chief Executive Officer, MetroHealth Community Health Centers
MetroHealth Community Health Centers / The MetroHealth System
2169658562 | Campitelli, Angela
340B Pharmacy Manager
The MetroHealth System
3303277871 | 1/27/2022 9:55 AM |
Details | Last Recertification Date | Update | Recertification | | 2/2/2021 9:18:07 PM | 2/2/2021 9:18 PM |
Details | State | Update | | Approved | Active | 1/1/2021 12:01 AM |
Contacts | Signed By | Insert | New Registration | | Jacono, Julie
Chief Strategy Officer
MetroHealth Community Health Center
2163102711 | 11/18/2020 10:59 AM |
Details | 340B ID | Update | New Registration | | FQHCLA415 | 11/18/2020 10:59 AM |
Dates | Participating Approval Date | Update | New Registration | | 11/18/2020 10:59:01 AM | 11/18/2020 10:59 AM |
Details | State | Update | New Registration | Pending | Approved | 11/18/2020 10:59 AM |
Dates | Signed By Date | Update | New Registration | | 11/17/2020 5:30:05 PM | 11/18/2020 10:59 AM |
Dates | Start Date | Update | New Registration | | 1/1/2021 12:00:00 AM | 11/18/2020 10:59 AM |
Addresses | Main Address | Insert | New Registration | |
11100 Saint Clair Ave
Cleveland, OH 44108-1943 | 11/17/2020 5:14 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1316573900 | 11/17/2020 5:14 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | OH | 11/17/2020 5:14 PM |
Contacts | Primary Contact | Insert | New Registration | | Nagel, Katherine F
Chief Executive Officer, MetroHealth Community Health Centers
MetroHealth Community Health Centers / The MetroHealth System
2169658562 | 11/17/2020 5:14 PM |
Contacts | Authorizing Official | Insert | New Registration | | Jacono, Julie
Chief Strategy Officer
MetroHealth Community Health Center
2163102711 | 11/17/2020 5:14 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Last Recertification Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Grant Number | Insert | New Registration | | LALCS33966 | 11/17/2020 5:14 PM |
Details | 340B ID | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 11/17/2020 5:14 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Medicare Provider Number | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Entity Name | Insert | New Registration | | MetroHealth System, The | 11/17/2020 5:14 PM |
Details | NOFO Number | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | Program Code | Insert | New Registration | | FQHCLA | 11/17/2020 5:14 PM |
Details | Entity Subname | Insert | New Registration | | Glenville Community Health Center | 11/17/2020 5:14 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Details | State | Insert | New Registration | | Pending | 11/17/2020 5:14 PM |
Dates | Registration Date | Insert | New Registration | | 11/17/2020 5:14:07 PM | 11/17/2020 5:14 PM |
Dates | Signed By Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Dates | Start Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Terminations | Termination Comments | Insert | New Registration | | | 11/17/2020 5:14 PM |
Terminations | Termination Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 11/17/2020 5:14 PM |
Terminations | Termination Reason | Insert | New Registration | | | 11/17/2020 5:14 PM |