Covered Entity Details

DSH360211E TRINITY HOSPITAL HOLDING COMPANY (Active) - information as of 6/6/2025 12:42:30 PM

Main Details

Name

TRINITY HOSPITAL HOLDING COMPANY

Subdivision Name

TRINITY MEDICAL CENTER EAST - Psychiatry

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360211E

Medicare Provider Number

360211

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/31/2022

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Trinity Health System
Dave Werkin, CFO
(740) 264-8695

Primary Contact

Trinity Health System
Jennifer Davis, System Director of Pharmacy
(740) 264-8663

Addresses

Street Address

380 SUMMIT AVE
STEUBENVILLE, OH 43952-2667

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	0240386	1285715144
WV	0001071000	1285715144
PA	1009879440001	1285715144

Shipping Addresses

Shipping Address 1

Trinity West
4000 Johnson Rd
Steubenville, OH 43952

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
DSH360211A	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	Cancer Center - Oncology	3204 Johnson Road	Steubenville	OH	Active
DSH360211B	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY EXPRESS CARE - URGENT CARE CENTER	150 MAIN ST	WINTERSVILLE	OH	Active
DSH360211C	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	Trinity Endoscopy Center - Endoscopy Services	1805 Sinclair Ave	Steubenville	OH	Active
DSH360211D	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	CADIZ EXPRESS CARE - Trinity Express Clinic - Cadiz	82424 CADIZ JEWETT RD	CADIZ	OH	Active
DSH360211E	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY MEDICAL CENTER EAST - Psychiatry	380 SUMMIT AVE	STEUBENVILLE	OH	Active
DSH360211F	Child	DSH	TRINITY HOSPITAL HOLDING COMPANY	TRINITY MEDICAL CENTER EAST - Workcare	380 SUMMIT AVE	STEUBENVILLE	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 1:14:45 PM	8/15/2024 6:33:03 AM	8/15/2024 6:33 AM
Details	Last Recertification Date	Update	Recertification		8/28/2023 1:14:45 PM	8/28/2023 1:14 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Werkin, Dave CFO Trinity Health System 7402648695	10/31/2022 7:02 AM
Details	340B ID	Update	New Registration		DSH360211E	10/31/2022 7:02 AM
Details	Entity Subname	Update	New Registration	TRINITY MEDICAL CENTER EAST	TRINITY MEDICAL CENTER EAST - Psychiatry	10/31/2022 7:02 AM
Dates	Participating Approval Date	Update	New Registration		10/31/2022 7:02:00 AM	10/31/2022 7:02 AM
Details	State	Update	New Registration	Pending	Approved	10/31/2022 7:02 AM
Dates	Signed By Date	Update	New Registration		10/14/2022 1:00:22 PM	10/31/2022 7:02 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/31/2022 7:02 AM
Addresses	Main Address	Insert	New Registration		380 SUMMIT AVE STEUBENVILLE, OH 43952-2667	10/13/2022 2:47 PM
Addresses	Shipping Address	Insert	New Registration		Trinity West 4000 Johnson Rd Steubenville, OH 43952	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0240386	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001071000	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1009879440001	10/13/2022 2:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/13/2022 2:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285715144	10/13/2022 2:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/13/2022 2:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285715144	10/13/2022 2:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/13/2022 2:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285715144	10/13/2022 2:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/13/2022 2:47 PM
Contacts	Primary Contact	Insert	New Registration		Davis, Jennifer System Director of Pharmacy Trinity Health System 7402648663	10/13/2022 2:47 PM
Contacts	Authorizing Official	Insert	New Registration		Werkin, Dave CFO Trinity Health System 7402648695	10/13/2022 2:47 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2022 2:47 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2022 2:47 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2022 2:47 PM
Details	Grant Number	Insert	New Registration			10/13/2022 2:47 PM
Details	340B ID	Insert	New Registration			10/13/2022 2:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2022 2:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2022 2:47 PM
Details	Medicare Provider Number	Insert	New Registration		360211	10/13/2022 2:47 PM
Details	Entity Name	Insert	New Registration		TRINITY HOSPITAL HOLDING COMPANY	10/13/2022 2:47 PM
Details	NOFO Number	Insert	New Registration			10/13/2022 2:47 PM
Details	Program Code	Insert	New Registration		DSH	10/13/2022 2:47 PM
Details	Entity Subname	Insert	New Registration		TRINITY MEDICAL CENTER EAST	10/13/2022 2:47 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2022 2:47 PM
Details	State	Insert	New Registration		Pending	10/13/2022 2:47 PM
Dates	Registration Date	Insert	New Registration		10/13/2022 2:47:26 PM	10/13/2022 2:47 PM
Dates	Signed By Date	Insert	New Registration			10/13/2022 2:47 PM
Dates	Start Date	Insert	New Registration			10/13/2022 2:47 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2022 2:47 PM
Terminations	Termination Date	Insert	New Registration			10/13/2022 2:47 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2022 2:47 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2022 2:47 PM