Covered Entity Details

FQHCLA415 MetroHealth System, The (Active) - information as of 5/28/2025 6:28:28 PM

Main Details

Name

MetroHealth System, The

Subdivision Name

Glenville Community Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-030391

340B ID

FQHCLA415

Grant Number

LALCS33966

Additional Details

Current Program Status

Active

Registration Date

11/17/2020

Participating Start Date

1/1/2021

Participating Approval Date

11/18/2020

Last Recertification Date

2/25/2025

Contacts

Authorizing Official

MetroHealth Community Health Centers / The MetroHealth System
Katherine F Nagel, Chief Executive Officer, MetroHealth Community Health Centers
(216) 965-8562

Primary Contact

The MetroHealth System
Angela Campitelli, Director 340B Program
(216) 778-5008

Addresses

Street Address

11100 Saint Clair Ave
Cleveland, OH 44108-1943

Billing Address

The MetroHealth System
2500 Metrohealth Drive
Cleveland, OH 44109-1900

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	0443356,2154636,2310609,2796792,0102983,0112018,0429409,0079638,0444643,0181115,0112033,0175949,0175941,0164524	1316573900,1609818681,1750329264,1942493663,1427478858,1821497306,1871180026,1992529911,1770164592,1518410869,1043619604,1063873297,1225499775,1053772715

Shipping Addresses

Shipping Address 1

The MetroHealth System Glenville Community Health Center
11100 Saint Clair Ave
Cleveland, OH 44108-1943

Shipping Address 2

The MetroHealth System FQHCLAL Storeroom
2500 Metrohealth Drive
RM 2205
Cleveland, OH 44109-1900

Shipping Address 3

The MetroHealth System DBA MetroHealth Central Fill/Mail Order/Specialty Pharmacy
9885 Rockside Rd
Ste 157
Valley View, OH 44125-6272

Shipping Address 4

The MetroHealth System DBA MetroHealth Brooklyn Pharmacy
5208 Memphis Ave
Cleveland, OH 44144

Shipping Address 5

The MetroHealth System DBA Buckeye Health Center Pharmacy
2816 E 116th St
Cleveland, OH 44120-2111

Shipping Address 6

The MetroHealth System DBA Bedford Health Center Pharmacy
19999 Rockside Rd
Bedford, OH 44146-2074

Shipping Address 7

The MetroHealth System DBA MetroHealth Broadway Pharmacy
6835 Broadway Ave
Cleveland, OH 44105-1313

Shipping Address 8

The MetroHealth System DBA MetroHealth Cleveland Heights Pharmacy
10 Severance Circle
Cleveland Heights, OH 44118-1533

Shipping Address 9

MetroHealth System DBA MetroHealth Plaza Pharmacy
2500 MetroHealth Dr
Cleveland, OH 44109-1900

Shipping Address 10

The MetroHealth System DBA MetroHealth Old Brooklyn Pharmacy
4229 Pearl Rd SM2-80
Cleveland, OH 44109-4218

Shipping Address 11

The MetroHealth System DBA MetroHealth Parma Pharmacy
12301 Snow Road
Parma, OH 44130-1002

Shipping Address 12

The MetroHealth Stystem DBA MetroHealth Brecksville Pharmacy
9200 Treeworth Blvd
Brecksville, OH 44141-2591

Shipping Address 13

The MetroHealth System DBA MetroHealth Buckeye Health Center
2816 E 116th ST
Cleveland, OH 44120-2111

Shipping Address 14

The MetroHealth System DBA MetroHealth Middleburg Hts Pharmacy
7800 Pearl Rd
Middleburg Hts, OH 44130-6552

Shipping Address 15

TheMetroHealth System DBA MetroHealth Ohio City Phcy
4757 Lorain Ave
Cleveland, OH 44102-3442

Shipping Address 16

The MetroHealth System DBA MetroHealth Beachwood Phcy
3609 Park East Dr
1st Floor
Beachwood, OH 44122-4309

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #4071	475 E 185TH STREET	EUCLID	OH	44119	01/15/2021	04/01/2021	11/29/2023	02/19/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #2665	10502 SAINT CLAIR AVENUE	CLEVELAND	OH	44108	01/15/2021	04/01/2021	02/01/2023	02/20/2024
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #2640	5411 SUPERIOR AVENUE	CLEVELAND	OH	44103	01/15/2021	04/01/2021	01/12/2024	02/19/2024
Contract Detail	SHELIGA DRUG INC	SHELIGA	6025 SAINT CLAIR AVE	CLEVELAND	OH	44103-1449	01/15/2021	04/01/2021		04/01/2021

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA415	Active	BPS-LAL-030391	MetroHealth System, The	Glenville Community Health Center	11100 Saint Clair Ave	Cleveland	OH
FQHCLA415A	Active	BPS-LAL-032425	MetroHealth System, The	Broadway Dental Clinic	6835 Broadway Ave	Cleveland	OH
FQHCLA415B	Active	BPS-LAL-032872	MetroHealth System, The	MHCHC Mobile Clinic	2500 Metrohealth Drive	Cleveland	OH
FQHCLA415C	Active	BPS-LAL-038336	METROHEALTH SYSTEM, THE	Heights Wellness Center	13263 Cedar Rd	Cleveland Heights	OH
FQHCLA415D	Active	BPS-LAL-038335	METROHEALTH SYSTEM, THE	Bedford Health Center	19999 Rockside Rd	Bedford	OH
FQHCLA415E	Active	BPS-LAL-038337	METROHEALTH SYSTEM, THE	Buckeye Health Center	2816 E 116th St	Cleveland	OH
FQHCLA415F	Active	BPS-LAL-038226	METROHEALTH SYSTEM, THE	Brooklyn Health Center	5208 Memphis Ave	Cleveland	OH
FQHCLA415G	Active	BPS-LAL-038215	METROHEALTH SYSTEM, THE	Gordon Square Health Center	6705 Detroit Ave	Cleveland	OH
FQHCLA415H	Active	BPS-LAL-038211	METROHEALTH SYSTEM, THE	Collinwood Health Center	15500 S Waterloo Rd	Cleveland	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA415	RITE AID OF OHIO, INC.	RITE AID #4071	475 E 185TH STREET	EUCLID	OH	44119	04/01/2021	11/29/2023
FQHCLA415	RITE AID OF OHIO, INC.	RITE AID #2665	10502 SAINT CLAIR AVENUE	CLEVELAND	OH	44108	04/01/2021	02/01/2023
FQHCLA415	RITE AID OF OHIO, INC.	RITE AID #2640	5411 SUPERIOR AVENUE	CLEVELAND	OH	44103	04/01/2021	01/12/2024
FQHCLA415	SHELIGA DRUG INC	SHELIGA	6025 SAINT CLAIR AVE	CLEVELAND	OH	44103-1449	04/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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

340B Drug Pricing Program Database