Covered Entity Details

DSH360137BA UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER (Active) - information as of 4/25/2025 5:43:15 PM

Main Details

Name

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

Subdivision Name

UH Seidman Cancer Center at UH Avon Health Center - Medical Oncology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360137BA

Medicare Provider Number

360137

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/6/2022

Participating Start Date

7/21/2022

Participating Approval Date

7/21/2022

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

University Hospitals
Tricia L Bires, Vice President, Treasury
(216) 767-8708

Primary Contact

University Hospitals Health System
Ryan Rosenthal, Manager of Reimbursement
(216) 767-8138

Addresses

Street Address

2075 Healthway Drive
Avon, OH 44011

Billing Address
Same as Street Address

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	8962421	1043397292

Shipping Addresses

Same as Street Address

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
DSH360137A	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / Medical Oncology	3909 ORANGE PLACE, STE 1100	ORANGE VILLAGE	OH	Active
DSH360137AA	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Minoff Health Center at Chagrin Highlands / Radiology	3909 Orange Pl	Orange Village	OH	Terminated
DSH360137AB	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center Neurology	3909 Orange Pl, STE 2300A	Orange Village	OH	Active
DSH360137AC	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH WESTLAKE HEALTH CENTER / Seidman Cancer Center	960 CLAGUE RD	WESTLAKE	OH	Terminated
DSH360137AD	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / Digestive Health Institute	3909 Orange Pl, STE 3200	Orange Village	OH	Active
DSH360137AE	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / Harrington Heart and Vascular Institute, Non Invasive Cardiology	3909 Orange Pl, STE 3300	Orange Village	OH	Active
DSH360137AF	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH CHAGRIN HIGHLANDS MEDICAL CENTER / Cancer Center	3909 ORANGE PL	BEACHWOOD	OH	Terminated
DSH360137AG	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Sharon Health Center - Radiology	5133 Ridge Road	Sharon Center	OH	Terminated
DSH360137AH	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	RAINBOW CENTER FOR WOMEN AND CHILDREN - MAC HOUSE IMAGING - MAC HOUSE IMAGING	5805 EUCLID AVE, STE 200	CLEVELAND	OH	Terminated
DSH360137AJ	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	RAINBOW CENTER FOR WOMEN AND CHILDREN - OB CLINC - OB CLINIC	5805 EUCLID AVE, STE 200	CLEVELAND	OH	Active
DSH360137AK	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / Medical Oncology - Medical Oncology	3909 Orange Place, STE 4600	Orange Village	OH	Active
DSH360137AL	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Westlake Health Center - Coumadin Clinic	960 Clague Road, STE 2300	Westlake	OH	Active
DSH360137AM	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Kathy Risman Pavilion - Fertility Center	1000 Auburn Drive, STE 310	Beachwood	OH	Active
DSH360137AN	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Fertility Center Westlake - Fertility Clinic	2055 Crocker Rd, STE 206	Westlake	OH	Active
DSH360137AP	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Mentor Health Center - Physical Therapy	9000 Mentor Ave	Mentor	OH	Terminated
DSH360137AQ	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Geauga Medical Center - Medical Oncology	13207 Ravenna Rd, STE 1900	Chardon	OH	Active
DSH360137AR	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Geauga Medical Center - Radiation Oncology	13207 Ravenna Rd, STE 1900	Chardon	OH	Terminated
DSH360137AS	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Geauga Medical Center - Infusion Center	13207 Ravenna Rd, STE 1900	Chardon	OH	Active
DSH360137AT	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Parma Medical Center - Medical Oncology	7007 Powers Blvd	Parma	OH	Active
DSH360137AU	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Parma Medical Center - Radiation Oncology	7007 Powers Blvd	Parma	OH	Active
DSH360137AV	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Parma Medical Center - Infusion Center	7007 Powers Blvd	Parma	OH	Active
DSH360137AW	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Mentor Hopkins Health Center / Cardiology Suite - Adult EKG	9000 Mentor Ave, STE 212	Mentor	OH	Active
DSH360137AX	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Mentor Hopkins Health Center / Coumadin Clinic - Coumadin Clinic	9000 Mentor Ave, STE 212	Mentor	OH	Active
DSH360137AY	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Hudson Health Center / Physical Therapy - Physical Therapy	5778 Darrow Rd, STE 105	Hudson	OH	Active
DSH360137AZ	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Otis Moss Medical Center - Moss Clinic Adult	8819 Quincy Ave	Cleveland	OH	Active
DSH360137B	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Westlake Medical Center / Medical Oncology	960 CLAGUE ROAD	WESTLAKE	OH	Terminated
DSH360137BA	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at UH Avon Health Center - Medical Oncology	2075 Healthway Drive	Avon	OH	Active
DSH360137BB	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at Mentor Health Center - Medical Oncology	9485 Mentor Ave, STE 3	Mentor	OH	Active
DSH360137BC	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at UH Avon Health Center - Radiation Oncology	2075 Healthway Drive	Avon	OH	Active
DSH360137BD	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at Mentor Health Center - Radiation Oncology	9485 Mentor Ave, STE 3	Mentor	OH	Active
DSH360137BE	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Landerbrook Health Center - Uro Gynecology	5850 Landerbrook Drive, STE 210	Mayfield Heights	OH	Active
DSH360137BF	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UHCMC/MACDONALD WOMEN'S HOSPITAL	25001 Emery Rd, STE 125A	Cleveland	OH	Terminated
DSH360137BG	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH TWINSBURG TOWN CENTER - OB Practice	8900 Darrow Road, STE H111	Twinsburg	OH	Active
DSH360137BH	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	MACDONALD WOMEN'S HOSPITAL AT RISMAN PAVILION - OBGYN Clinic	1000 Auburn Drive, STE 320	Beachwood	OH	Active
DSH360137BJ	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	MACDONALD WOMEN'S HOSPITAL AT CROCKER - OBGYN Clinic	2055 Crocker Road, STE 206B	Westlake	OH	Active
DSH360137BK	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / Radiation Oncology - Radiation Oncology	3909 ORANGE PLACE, STE 1100	ORANGE VILLAGE	OH	Active
DSH360137BL	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Minoff Health Center at Chagrin Highlands / SCC Infusion Center - SCC Infusion	3909 ORANGE PLACE, STE 1100	ORANGE VILLAGE	OH	Active
DSH360137BM	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at UH Avon Health Center - SCC Infusion Center - SCC Infusion	2075 Healthway Drive	Avon	OH	Active
DSH360137BN	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Seidman Cancer Center at Mentor Health Center - SCC infusion Center - SCC Infusion	9485 Mentor Ave, STE 3	Mentor	OH	Active
DSH360137C	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	SUBURBAN HEALTH CENTER	1611 SOUTH GREEN ROAD	SOUTH EUCLID	OH	Terminated
DSH360137D	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Seidman Cancer Center at Monarch Building (Landerbrook II) / Medical Oncology	5885 LANDERBROOK DRIVE	MAYFIELD HEIGHTS	OH	Terminated
DSH360137E	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UHCMC SCC	13207 RAVENNA ROAD	CHARDON	OH	Terminated
DSH360137F	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	TWINSBURG HEALTH CENTER	8819 COMMONS BLVD	TWINSBURG	OH	Terminated
DSH360137G	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH St John Medical Center / Medical Oncology	29325 Health Campus Drive, STE 1	WESTLAKE	OH	Active
DSH360137H	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	CONCORD HEALTH CENTER	7500 AUBURN ROAD	CONCORD TWP	OH	Terminated
DSH360137J	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	MEDINA HEALTH CENTER	4001 CARRICK DRIVE	MEDINA	OH	Terminated
DSH360137K	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Sharon Health Center / Seidman Cancer Center Infusion Center	5133 RIDGE ROAD	WADSWORTH	OH	Active
DSH360137L	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Mentor Hopkins Health Center / Surgery Center	9000 Mentor Avenue, STE 220	Mentor	OH	Active
DSH360137M	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Suburban Health Center/Surgery Center Suite	1611 S. Green Road, STE 124	South Euclid	OH	Active
DSH360137N	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Portage Medical Center / SCC Radiation Oncology	6847 N CHESTNUT ST, STE 10	RAVENNA	OH	Active
DSH360137P	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Portage Medical Center / Medical Oncology	6847 N CHESTNUT ST 310	RAVENNA	OH	Active
DSH360137Q	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Portage Medical Center / Seidman Cancer Center Infusion	6847 N CHESTNUT ST, STE 310	RAVENNA	OH	Active
DSH360137R	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Sharon Health Center / Medical Oncology	5133 Ridge Road	Wadsworth	OH	Active
DSH360137S	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Westlake Health Center / Cardiology Suite	960 Clague Rd, STE 2300	Westlake	OH	Active
DSH360137T	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Westlake Health Center / Digestive Health Institute	960 Clague Rd, STE 2100	Westlake	OH	Active
DSH360137U	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Westlake Health Center / Radiology Suite	960 Clague Rd	Westlake	OH	Terminated
DSH360137V	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Westlake Health Center / Wound Clinic Suite	960 Clague Rd, STE 2300	Westlake	OH	Active
DSH360137W	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Sharon Health Center / MRI Mobile	5133 RIDGE RD 2	Sharon Center	OH	Terminated
DSH360137X	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Westlake Health Center / Surgery Center Suite	960 Clague RD, STE 2200	Westlake	OH	Active
DSH360137Y	Child	DSH	UNIVERSITY HOSPITALS OF CLEVELAND	UH Minoff Health Center at Chagrin Highlands / Nuclear Medicine	3909 Orange Pl	Orange Village	OH	Terminated
DSH360137Z	Child	DSH	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	UH Ahuja Medical Center / Breast Center	3999 Richmond Road, STE 1100	Beachwood	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Daniels, Dana SFA University Hospitals 2162860111	Rosenthal, Ryan Manager of Reimbursement University Hospitals Health System 2167678138	2/20/2025 7:56 AM
Details	Last Recertification Date	Update	Recertification	9/2/2023 8:55:50 AM	8/27/2024 8:27:16 AM	8/27/2024 8:27 AM
Contacts	Authorizing Official	Update	AO Change Request	Schillero, Anthony James Director, Financial Planning and Analysis University Hospitals 2167890429	Bires, Tricia L Vice President, Treasury University Hospitals 2167678708	5/28/2024 6:19 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 7:46:43 AM	9/2/2023 8:55:50 AM	9/2/2023 8:55 AM
Details	Entity Name	Update	Change Request	UNIVERSITY HOSPITALS OF CLEVELAND	UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	3/24/2023 7:59 AM
Contacts	Authorizing Official	Update	Change Request	Vehovec, Michael R. Corporate Controller UH 2167678729	Schillero, Anthony James Director, Financial Planning and Analysis University Hospitals 2167890429	11/29/2022 1:32 PM
Details	Last Recertification Date	Update	Recertification		8/25/2022 7:46:43 AM	8/25/2022 7:46 AM
Details	State	Update	OPA Edit	Approved	Active	7/21/2022 1:15 PM
Dates	Start Date	Update	OPA Edit	10/1/2022 12:00:00 AM	7/21/2022 12:00:00 AM	7/21/2022 1:15 PM
Contacts	Signed By	Insert	New Registration		Vehovec, Michael R. Corporate Controller UH 2167678729	7/21/2022 12:57 PM
Details	340B ID	Update	New Registration		DSH360137BA	7/21/2022 12:57 PM
Details	Entity Name	Update	New Registration	UH CLEVELAND MEDICAL CENTER	UNIVERSITY HOSPITALS OF CLEVELAND	7/21/2022 12:57 PM
Details	Entity Subname	Update	New Registration	UH Seidman Cancer Center at UH Avon Health Center	UH Seidman Cancer Center at UH Avon Health Center - Medical Oncology	7/21/2022 12:57 PM
Dates	Participating Approval Date	Update	New Registration		7/21/2022 12:57:06 PM	7/21/2022 12:57 PM
Details	State	Update	New Registration	Pending	Approved	7/21/2022 12:57 PM
Dates	Signed By Date	Update	New Registration		7/6/2022 2:09:00 PM	7/21/2022 12:57 PM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/21/2022 12:57 PM
Addresses	Main Address	Insert	New Registration		2075 Healthway Drive Avon, OH 44011	7/6/2022 1:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/6/2022 1:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		8962421	7/6/2022 1:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	7/6/2022 1:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043397292	7/6/2022 1:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	7/6/2022 1:21 PM
Contacts	Authorizing Official	Insert	New Registration		Vehovec, Michael R. Corporate Controller UH 2167678729	7/6/2022 1:21 PM
Contacts	Primary Contact	Insert	New Registration		Daniels, Dana SFA University Hospitals 2162860111	7/6/2022 1:21 PM
Details	Assistance Received From Date	Insert	New Registration			7/6/2022 1:21 PM
Details	Assistance Received To Date	Insert	New Registration			7/6/2022 1:21 PM
Details	Last Recertification Date	Insert	New Registration			7/6/2022 1:21 PM
Details	Grant Number	Insert	New Registration			7/6/2022 1:21 PM
Details	340B ID	Insert	New Registration			7/6/2022 1:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/6/2022 1:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/6/2022 1:21 PM
Details	Medicare Provider Number	Insert	New Registration		360137	7/6/2022 1:21 PM
Details	Entity Name	Insert	New Registration		UH CLEVELAND MEDICAL CENTER	7/6/2022 1:21 PM
Details	NOFO Number	Insert	New Registration			7/6/2022 1:21 PM
Details	Program Code	Insert	New Registration		DSH	7/6/2022 1:21 PM
Details	Entity Subname	Insert	New Registration		UH Seidman Cancer Center at UH Avon Health Center	7/6/2022 1:21 PM
Dates	Participating Approval Date	Insert	New Registration			7/6/2022 1:21 PM
Details	State	Insert	New Registration		Pending	7/6/2022 1:21 PM
Dates	Registration Date	Insert	New Registration		7/6/2022 1:21:11 PM	7/6/2022 1:21 PM
Dates	Signed By Date	Insert	New Registration			7/6/2022 1:21 PM
Dates	Start Date	Insert	New Registration			7/6/2022 1:21 PM
Terminations	Termination Comments	Insert	New Registration			7/6/2022 1:21 PM
Terminations	Termination Date	Insert	New Registration			7/6/2022 1:21 PM
Terminations	Termination Effective Date	Insert	New Registration			7/6/2022 1:21 PM
Terminations	Termination Reason	Insert	New Registration			7/6/2022 1:21 PM