Covered Entity Details

RRC360066-06 ST. RITAS MEDICAL CENTER LLC (Active) - information as of 6/16/2025 11:17:17 PM

Main Details

Name

ST. RITAS MEDICAL CENTER LLC

Subdivision Name

Mercy Health - Eastside Urgent Care - Mercy Health - Eastside Urgent Care

Type

Rural Referral Center

Rural

Yes

340B ID

RRC360066-06

Medicare Provider Number

360066

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/12/2021

Participating Start Date

7/26/2021

Participating Approval Date

7/22/2021

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

St. Rita's Medical Center LLC
Nicole R Hutchison, CFO
(419) 226-4584

Primary Contact

St. Rita's Medical Center LLC
Kristi Ziegenbusch, Director of Pharmacy
(419) 996-5578

Addresses

Street Address

967 BELLEFONTAINE AVE
Suite 100
Lima, OH 45804

Billing Address

ST. RITAS MEDICAL CENTER LLC
730 W. Market Street
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. RITAS MEDICAL CENTER LLC
730 W. Market Street
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
RRC360066-01	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Allison Radiation Oncology - Mercy Health - Allison Radiation Oncology	803 W MARKET ST	Lima	OH	Active
RRC360066-02	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Celina Medical Oncology - Mercy Health - Celina Medical Oncology	900 Havemann Road	Celina	OH	Active
RRC360066-03	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Imaging and Lab Services - CT - Mercy Health - Delphos Imaging and Lab Services - CT	1800 E 5TH St.	Delphos	OH	Terminated
RRC360066-04	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Rehabilitation and Therapy - PT - Mercy Health - Delphos Rehabilitation and Therapy - PT	1800 E 5TH St.	Delphos	OH	Terminated
RRC360066-05	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Delphos Urgent Care - Mercy Health - Delphos Urgent Care	1800 E 5TH St.	Delphos	OH	Active
RRC360066-06	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Eastside Urgent Care - Mercy Health - Eastside Urgent Care	967 BELLEFONTAINE AVE	Lima	OH	Active
RRC360066-07	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Cancer Center - Mercy Health - St. Rita's Cancer Center	803 W MARKET ST	Lima	OH	Active
RRC360066-08	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County Medical Center - Outpatient Services	601 STATE ROUTE 224	Ottawa	OH	Active
RRC360066-09	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County Radiology - Mercy Health - Putnam County Radiology	601 STATE ROUTE 224	Glandorf	OH	Terminated
RRC360066-10	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Surgery Center - Mercy Health - St. Rita's Surgery Center	770 W HIGH ST	Lima	OH	Active
RRC360066-11	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Westside Urgent Care - IV Therapy	2195 ALLENTOWN RD	Lima	OH	Active
RRC360066-12	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Westside Urgent Care - Mercy Health - Westside Urgent Care	2195 ALLENTOWN RD	Lima	OH	Active
RRC360066-13	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - St. Rita's Wound and Ostomy Care - Mercy Health - St. Rita's Wound and Ostomy Care	830 W HIGH ST	Lima	OH	Active
RRC360066-14	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Home Infusion, Lima - Home Infusion	959 W. North Street	Lima	OH	Active
RRC360066-15	Child	RRC	ST. RITAS MEDICAL CENTER LLC	Mercy Health - Putnam County Medical Center - Emergency	601 STATE ROUTE 224	Ottawa	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Hutchison, Nicole R CFO Mercy Health - St. Rita's 4192264584	Hutchison, Nicole R CFO St. Rita's Medical Center LLC 4192264584	1/29/2025 1:10 PM
Details	Last Recertification Date	Update	Recertification	8/25/2023 9:06:13 AM	8/27/2024 3:24:21 PM	8/27/2024 3:24 PM
Contacts	Authorizing Official	Update	AO Change Request	RIEGER, TIM Regional CFO & VP of Finance Mercy Health - St. Rita’s 4192269775	Hutchison, Nicole R CFO Mercy Health - St. Rita's 4192264584	7/15/2024 7:06 AM
Contacts	Primary Contact	Update	Group Change Request	Baluh, Kyle 340B Program Manager Bon Secours Mercy Health 4402272762	Ziegenbusch, Kristi Director of Pharmacy St. Rita's Medical Center LLC 4199965578	10/17/2023 8:13 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 3:19:19 PM	8/25/2023 9:06:13 AM	8/25/2023 9:06 AM
Contacts	Primary Contact	Update	Group Change Request	Brady, Lisa Director of Pharmacy Mercy Health - St. Rita's 4199965526	Baluh, Kyle 340B Program Manager Bon Secours Mercy Health 4402272762	7/26/2023 12:28 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 10:41:25 AM	9/1/2022 3:19:19 PM	9/1/2022 3:19 PM
Details	Last Recertification Date	Update	Recertification		9/1/2021 10:41:25 AM	9/1/2021 10:41 AM
Details	State	Update	OPA Edit	Approved	Active	7/26/2021 2:34 PM
Dates	Start Date	Update	OPA Edit	10/1/2021 12:00:00 AM	7/26/2021 12:00:00 AM	7/26/2021 2:34 PM
Contacts	Signed By	Insert	New Registration		RIEGER, TIM Regional CFO & VP of Finance Mercy Health - St. Rita’s 4192269775	7/22/2021 10:49 AM
Details	340B ID	Update	New Registration		RRC360066-06	7/22/2021 10:49 AM
Details	Entity Subname	Update	New Registration	Mercy Health - Eastside Urgent Care	Mercy Health - Eastside Urgent Care - Mercy Health - Eastside Urgent Care	7/22/2021 10:49 AM
Dates	Participating Approval Date	Update	New Registration		7/22/2021 10:49:06 AM	7/22/2021 10:49 AM
Details	State	Update	New Registration	Pending	Approved	7/22/2021 10:49 AM
Dates	Signed By Date	Update	New Registration		7/12/2021 4:20:45 PM	7/22/2021 10:49 AM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	7/22/2021 10:49 AM
Addresses	Main Address	Insert	New Registration		967 BELLEFONTAINE AVE Suite 100 Lima, OH 45804	7/12/2021 9:53 AM
Addresses	Billing Address	Insert	New Registration		ST. RITAS MEDICAL CENTER LLC 730 W. Market Street Lima, OH 45801	7/12/2021 9:53 AM
Addresses	Shipping Address	Insert	New Registration		ST. RITAS MEDICAL CENTER LLC 730 W. Market Street Lima, OH 45801	7/12/2021 9:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2021 9:53 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7649503	7/12/2021 9:53 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	7/12/2021 9:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1811939887	7/12/2021 9:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	7/12/2021 9:53 AM
Contacts	Authorizing Official	Insert	New Registration		RIEGER, TIM Regional CFO & VP of Finance Mercy Health - St. Rita’s 4192269775	7/12/2021 9:53 AM
Contacts	Primary Contact	Insert	New Registration		Brady, Lisa Director of Pharmacy Mercy Health - St. Rita's 4199965526	7/12/2021 9:53 AM
Details	Assistance Received From Date	Insert	New Registration			7/12/2021 9:53 AM
Details	Assistance Received To Date	Insert	New Registration			7/12/2021 9:53 AM
Details	Last Recertification Date	Insert	New Registration			7/12/2021 9:53 AM
Details	Grant Number	Insert	New Registration			7/12/2021 9:53 AM
Details	340B ID	Insert	New Registration			7/12/2021 9:53 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2021 9:53 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2021 9:53 AM
Details	Medicare Provider Number	Insert	New Registration		360066	7/12/2021 9:53 AM
Details	Entity Name	Insert	New Registration		ST. RITAS MEDICAL CENTER LLC	7/12/2021 9:53 AM
Details	NOFO Number	Insert	New Registration			7/12/2021 9:53 AM
Details	Program Code	Insert	New Registration		RRC	7/12/2021 9:53 AM
Details	Entity Subname	Insert	New Registration		Mercy Health - Eastside Urgent Care	7/12/2021 9:53 AM
Dates	Participating Approval Date	Insert	New Registration			7/12/2021 9:53 AM
Details	State	Insert	New Registration		Pending	7/12/2021 9:53 AM
Dates	Registration Date	Insert	New Registration		7/12/2021 9:53:34 AM	7/12/2021 9:53 AM
Dates	Signed By Date	Insert	New Registration			7/12/2021 9:53 AM
Dates	Start Date	Insert	New Registration			7/12/2021 9:53 AM
Terminations	Termination Comments	Insert	New Registration			7/12/2021 9:53 AM
Terminations	Termination Date	Insert	New Registration			7/12/2021 9:53 AM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2021 9:53 AM
Terminations	Termination Reason	Insert	New Registration			7/12/2021 9:53 AM