340B Drug Pricing Program Database


FQHCLA415 MetroHealth System, The (Active) - information as of 5/6/2025 12:01:23 AM

Main Details
MetroHealth System, The
Glenville Community Health Center
Health Center Program Look-Alike
BPS-LAL-030391
FQHCLA415
LALCS33966


Additional Details
Active
11/17/2020
1/1/2021
11/18/2020
2/25/2025

Contacts

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

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

Addresses

11100 Saint Clair Ave
Cleveland, OH 44108-1943

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
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OH0443356,2154636,2310609,2796792,0102983,0112018,0429409,0079638,0444643,0181115,0112033,0175949,0175941,01645241316573900,1609818681,1750329264,1942493663,1427478858,1821497306,1871180026,1992529911,1770164592,1518410869,1043619604,1063873297,1225499775,1053772715
Shipping Addresses

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The MetroHealth System DBA MetroHealth Beachwood Phcy
3609 Park East Dr
1st Floor
Beachwood, OH 44122-4309
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailRITE AID OF OHIO, INC.RITE AID #4071 475 E 185TH STREET
EUCLIDOH4411901/15/202104/01/2021 11/29/202302/19/2024
Contract DetailRITE AID OF OHIO, INC.RITE AID #2665 10502 SAINT CLAIR AVENUE
CLEVELANDOH4410801/15/202104/01/2021 02/01/202302/20/2024
Contract DetailRITE AID OF OHIO, INC.RITE AID #2640 5411 SUPERIOR AVENUE
CLEVELANDOH4410301/15/202104/01/2021 01/12/202402/19/2024
Contract DetailSHELIGA DRUG INCSHELIGA 6025 SAINT CLAIR AVE
CLEVELANDOH44103-144901/15/202104/01/2021  04/01/2021
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
FQHCLA415ActiveBPS-LAL-030391MetroHealth System, TheGlenville Community Health Center11100 Saint Clair Ave ClevelandOH
FQHCLA415AActiveBPS-LAL-032425MetroHealth System, TheBroadway Dental Clinic6835 Broadway Ave ClevelandOH
FQHCLA415BActiveBPS-LAL-032872MetroHealth System, TheMHCHC Mobile Clinic2500 Metrohealth Drive ClevelandOH
FQHCLA415CActiveBPS-LAL-038336METROHEALTH SYSTEM, THEHeights Wellness Center13263 Cedar Rd Cleveland HeightsOH
FQHCLA415DActiveBPS-LAL-038335METROHEALTH SYSTEM, THEBedford Health Center19999 Rockside Rd BedfordOH
FQHCLA415EActiveBPS-LAL-038337METROHEALTH SYSTEM, THEBuckeye Health Center2816 E 116th St ClevelandOH
FQHCLA415FActiveBPS-LAL-038226METROHEALTH SYSTEM, THEBrooklyn Health Center5208 Memphis Ave ClevelandOH
FQHCLA415GActiveBPS-LAL-038215METROHEALTH SYSTEM, THEGordon Square Health Center6705 Detroit Ave ClevelandOH
FQHCLA415HActiveBPS-LAL-038211METROHEALTH SYSTEM, THECollinwood Health Center15500 S Waterloo Rd ClevelandOH
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
FQHCLA415RITE AID OF OHIO, INC.RITE AID #4071 475 E 185TH STREET
EUCLIDOH4411904/01/2021 11/29/2023
FQHCLA415RITE AID OF OHIO, INC.RITE AID #2665 10502 SAINT CLAIR AVENUE
CLEVELANDOH4410804/01/2021 02/01/2023
FQHCLA415RITE AID OF OHIO, INC.RITE AID #2640 5411 SUPERIOR AVENUE
CLEVELANDOH4410304/01/2021 01/12/2024
FQHCLA415SHELIGA DRUG INCSHELIGA 6025 SAINT CLAIR AVE
CLEVELANDOH44103-144904/01/2021  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressUpdateChange RequestThe MetroHealth System DBA MetroHealth Broadway Pharmacy 6835 Broadway Ave 2167 Cleveland, OH 44105-1313The MetroHealth System DBA MetroHealth Broadway Pharmacy 6835 Broadway Ave Cleveland, OH 44105-13134/10/2025 10:02 AM
AddressesShipping AddressDeleteRecertificationThe MetroHealth System DBA MetroHealth Beachwood Phcy 3609 Park East Dr Beachwood, OH 44122-4309 2/25/2025 10:15 AM
AddressesShipping AddressInsertRecertification The MetroHealth System DBA MetroHealth Beachwood Phcy 3609 Park East Dr 1st Floor Beachwood, OH 44122-43092/25/2025 10:15 AM
DetailsLast Recertification DateUpdateRecertification2/19/2024 11:20:17 AM2/25/2025 10:15:46 AM2/25/2025 10:15 AM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Broadway Pharmacy 6835 Broadway Ave 2167 Cleveland, OH 44105-13131/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Cleveland Heights Pharmacy 10 Severance Circle Cleveland Heights, OH 44118-15331/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request MetroHealth System DBA MetroHealth Plaza Pharmacy 2500 MetroHealth Dr Cleveland, OH 44109-19001/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Old Brooklyn Pharmacy 4229 Pearl Rd SM2-80 Cleveland, OH 44109-42181/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Parma Pharmacy 12301 Snow Road Parma, OH 44130-10021/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth Stystem DBA MetroHealth Brecksville Pharmacy 9200 Treeworth Blvd Brecksville, OH 44141-25911/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Buckeye Health Center 2816 E 116th ST Cleveland, OH 44120-21111/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Middleburg Hts Pharmacy 7800 Pearl Rd Middleburg Hts, OH 44130-65521/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request TheMetroHealth System DBA MetroHealth Ohio City Phcy 4757 Lorain Ave Cleveland, OH 44102-34421/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Beachwood Phcy 3609 Park East Dr Beachwood, OH 44122-43091/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 21546361/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 23106091/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 27967921/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01029831/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01120181/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 04294091/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 00796381/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 04446431/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01811151/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01120331/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01759491/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01759411/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/29/2025 12:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 01645241/29/2025 12:57 PM
Medicaid BillingMedicaid: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 16098186811/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 17503292641/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 19424936631/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 14274788581/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 18214973061/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 18711800261/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 19925299111/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 17701645921/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 15184108691/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 10436196041/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 10638732971/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 12254997751/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
Medicaid BillingNPI: NumberInsertChange Request 10537727151/29/2025 12:57 PM
Medicaid BillingNPI: StateInsertChange Request OH1/29/2025 12:57 PM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA Buckeye Health Center Pharmacy 2816 E 116th St Cleveland, OH 44120-211112/4/2024 11:18 AM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA Bedford Health Center Pharmacy 19999 Rockside Rd Bedford, OH 44146-207412/4/2024 11:18 AM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Brooklyn Pharmacy 5208 Memphis Ave Cleveland, OH 4414412/4/2024 7:37 AM
AddressesShipping AddressInsertChange Request The MetroHealth System DBA MetroHealth Central Fill/Mail Order/Specialty Pharmacy 9885 Rockside Rd Ste 157 Valley View, OH 44125-627212/3/2024 8:13 AM
AddressesBilling AddressInsertChange Request The MetroHealth System 2500 Metrohealth Drive Cleveland, OH 44109-190010/11/2024 11:05 AM
AddressesShipping AddressInsertChange Request The MetroHealth System Glenville Community Health Center 11100 Saint Clair Ave Cleveland, OH 44108-194310/11/2024 11:05 AM
AddressesShipping AddressInsertChange Request The MetroHealth System FQHCLAL Storeroom 2500 Metrohealth Drive RM 2205 Cleveland, OH 44109-190010/11/2024 11:05 AM
DetailsLast Recertification DateUpdateRecertification2/14/2023 8:57:58 PM2/19/2024 11:20:17 AM2/19/2024 11:20 AM
ContactsPrimary ContactUpdateProfile Change RequestCampitelli, Angela 340B Pharmacy Manager The MetroHealth System 3303277871Campitelli, Angela Director 340B Program The MetroHealth System 21677850089/27/2023 3:55 PM
DetailsLast Recertification DateUpdateRecertification2/24/2022 3:58:25 PM2/14/2023 8:57:58 PM2/14/2023 8:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/24/2022 3:58 PM
Medicaid BillingMedicaid: NumberInsertRecertification 04433562/24/2022 3:58 PM
Medicaid BillingMedicaid: StateInsertRecertification OH2/24/2022 3:58 PM
DetailsLast Recertification DateUpdateRecertification2/2/2021 9:18:07 PM2/24/2022 3:58:25 PM2/24/2022 3:58 PM
ContactsAuthorizing OfficialUpdateChange RequestJacono, Julie Chief Strategy Officer MetroHealth Community Health Center 2163102711Nagel, Katherine F Chief Executive Officer, MetroHealth Community Health Centers MetroHealth Community Health Centers / The MetroHealth System 21696585621/27/2022 9:55 AM
ContactsPrimary ContactUpdateChange RequestNagel, Katherine F Chief Executive Officer, MetroHealth Community Health Centers MetroHealth Community Health Centers / The MetroHealth System 2169658562Campitelli, Angela 340B Pharmacy Manager The MetroHealth System 33032778711/27/2022 9:55 AM
DetailsLast Recertification DateUpdateRecertification 2/2/2021 9:18:07 PM2/2/2021 9:18 PM
DetailsStateUpdate ApprovedActive1/1/2021 12:01 AM
ContactsSigned ByInsertNew Registration Jacono, Julie Chief Strategy Officer MetroHealth Community Health Center 216310271111/18/2020 10:59 AM
Details340B IDUpdateNew Registration FQHCLA41511/18/2020 10:59 AM
DatesParticipating Approval DateUpdateNew Registration 11/18/2020 10:59:01 AM11/18/2020 10:59 AM
DetailsStateUpdateNew RegistrationPendingApproved11/18/2020 10:59 AM
DatesSigned By DateUpdateNew Registration 11/17/2020 5:30:05 PM11/18/2020 10:59 AM
DatesStart DateUpdateNew Registration 1/1/2021 12:00:00 AM11/18/2020 10:59 AM
AddressesMain AddressInsertNew Registration  11100 Saint Clair Ave Cleveland, OH 44108-194311/17/2020 5:14 PM
Medicaid BillingNPI: NumberInsertNew Registration 131657390011/17/2020 5:14 PM
Medicaid BillingNPI: StateInsertNew Registration OH11/17/2020 5:14 PM
ContactsPrimary ContactInsertNew Registration Nagel, Katherine F Chief Executive Officer, MetroHealth Community Health Centers MetroHealth Community Health Centers / The MetroHealth System 216965856211/17/2020 5:14 PM
ContactsAuthorizing OfficialInsertNew Registration Jacono, Julie Chief Strategy Officer MetroHealth Community Health Center 216310271111/17/2020 5:14 PM
DetailsAssistance Received From DateInsertNew Registration  11/17/2020 5:14 PM
DetailsAssistance Received To DateInsertNew Registration  11/17/2020 5:14 PM
DetailsLast Recertification DateInsertNew Registration  11/17/2020 5:14 PM
DetailsGrant NumberInsertNew Registration LALCS3396611/17/2020 5:14 PM
Details340B IDInsertNew Registration  11/17/2020 5:14 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  11/17/2020 5:14 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  11/17/2020 5:14 PM
DetailsMedicare Provider NumberInsertNew Registration  11/17/2020 5:14 PM
DetailsEntity NameInsertNew Registration MetroHealth System, The11/17/2020 5:14 PM
DetailsNOFO NumberInsertNew Registration  11/17/2020 5:14 PM
DetailsProgram CodeInsertNew Registration FQHCLA11/17/2020 5:14 PM
DetailsEntity SubnameInsertNew Registration Glenville Community Health Center11/17/2020 5:14 PM
DatesParticipating Approval DateInsertNew Registration  11/17/2020 5:14 PM
DetailsStateInsertNew Registration Pending11/17/2020 5:14 PM
DatesRegistration DateInsertNew Registration 11/17/2020 5:14:07 PM11/17/2020 5:14 PM
DatesSigned By DateInsertNew Registration  11/17/2020 5:14 PM
DatesStart DateInsertNew Registration  11/17/2020 5:14 PM
TerminationsTermination CommentsInsertNew Registration  11/17/2020 5:14 PM
TerminationsTermination DateInsertNew Registration  11/17/2020 5:14 PM
TerminationsTermination Effective DateInsertNew Registration  11/17/2020 5:14 PM
TerminationsTermination ReasonInsertNew Registration  11/17/2020 5:14 PM