Yes
St. Elizabeth Youngstown Inpatient Pharmacy
1044 Belmont Avenue FL 2
Youngstown, OH 44504
DSH360064A | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | MH-YOUNGST PEDI,WOMEN,SURG,INTER, P - Internal Medicine | 1001 Covington Street | Youngstown | OH | ToBeTerminated |
DSH360064B | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | MH-YOUNGST PEDI,WOMEN,SURG,INTER, P - Surgery | 1001 Covington Street | Youngstown | OH | ToBeTerminated |
DSH360064C | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | MH-YOUNGST PEDI,WOMEN,SURG,INTER, P - Pulmonary | 1001 Covington Street | Youngstown | OH | ToBeTerminated |
DSH360064D | Child | DSH | ST. ELIZABETH HEALTH CENTER | Ambulatory Care Center - Women's Center | 1001 Covington Street | Youngstown | OH | Terminated |
DSH360064E | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Austintown Medical Center - Emergency | 6252 Mahoning Avenue | Austintown | OH | ToBeTerminated |
DSH360064F | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Austintown Medical Center - MRI | 6252 Mahoning Avenue | Austintown | OH | ToBeTerminated |
DSH360064G | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Austintown Medical Center - CT | 6252 Mahoning Avenue | Austintown | OH | ToBeTerminated |
DSH360064H | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Austintown Medical Center - Diagnostic Radiology | 6252 Mahoning Avenue | Austintown | OH | ToBeTerminated |
DSH360064J | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Heart and Vascular Institute - Poland Cardiac Imaging | 715 E Western Reserve Road | Poland | OH | ToBeTerminated |
DSH360064K | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Heart and Vascular Institute - Belmont Youngstown Cardiac Imaging | 1001 Belmont Avenue | Youngstown | OH | ToBeTerminated |
DSH360064L | Child | DSH | MERCY HEALTH - ST. ELIZABETH YOUNGSTOWN HOSPITAL | Heart and Vascular Institute - Eastland Warren Cardiac Imaging | 627 Eastland Avenue SE STE 101 | Warren | OH | ToBeTerminated |
DSH360064M | Child | DSH | ST. ELIZABETH HEALTH CENTER | Youngstown Primary Care - Primary Care | 1053 Belmont Avenue | Youngstown | OH | Terminated |
Contacts | Primary Contact | Update | Profile Change Request | Baluh, Kyle
340B Program Manager
Bon Secours Mercy Health
4402272762 | Baluh, Kyle
Director, 340B Programs
Bon Secours Mercy Health
4402272762 | 11/18/2024 9:38 AM |
Details | State | Update | | To Be Terminated | Terminated | 7/1/2023 12:01 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 2/27/2023 12:00:00 AM | 4/26/2023 11:59 AM |
Details | State | Update | Termination Request | Active | To Be Terminated | 4/26/2023 11:59 AM |
Terminations | Termination Date | Update | Termination Request | | 7/1/2023 12:00:00 AM | 4/26/2023 11:59 AM |
Terminations | Termination Effective Date | Update | Termination Request | | 2/27/2023 12:00:00 AM | 4/26/2023 11:59 AM |
Terminations | Termination Reason | Update | Termination Request | | Hospital Outpatient facility no longer eligible | 4/26/2023 11:59 AM |
Details | State | Update | | Approved | Active | 1/1/2023 12:01 AM |
Contacts | Signed By | Insert | New Registration | | Crawford, Michelle L
Market CFO Youngstown
Bon Secours Mercy Health
3307188096 | 11/2/2022 7:19 AM |
Details | 340B ID | Update | New Registration | | DSH360064M | 11/2/2022 7:19 AM |
Details | Entity Subname | Update | New Registration | Youngstown Primary Care | Youngstown Primary Care - Primary Care | 11/2/2022 7:19 AM |
Dates | Participating Approval Date | Update | New Registration | | 11/2/2022 7:19:44 AM | 11/2/2022 7:19 AM |
Details | State | Update | New Registration | Pending | Approved | 11/2/2022 7:19 AM |
Dates | Signed By Date | Update | New Registration | | 10/14/2022 1:16:54 PM | 11/2/2022 7:19 AM |
Dates | Start Date | Update | New Registration | | 1/1/2023 12:00:00 AM | 11/2/2022 7:19 AM |
Addresses | Main Address | Insert | New Registration | |
1053 Belmont Avenue
Youngstown, OH 44504 | 10/14/2022 11:13 AM |
Addresses | Billing Address | Insert | New Registration | | St. Elizabeth Youngstown Inpatient Pharmacy
1044 Belmont Avenue FL 2
Youngstown, OH 44504 | 10/14/2022 11:13 AM |
Addresses | Shipping Address | Insert | New Registration | | St. Elizabeth Youngstown Inpatient Pharmacy
1044 Belmont Avenue FL 2
Youngstown, OH 44504 | 10/14/2022 11:13 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/14/2022 11:13 AM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 7645338 | 10/14/2022 11:13 AM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | OH | 10/14/2022 11:13 AM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1548296106 | 10/14/2022 11:13 AM |
Medicaid Billing | NPI: State | Insert | New Registration | | OH | 10/14/2022 11:13 AM |
Contacts | Primary Contact | Insert | New Registration | | Baluh, Kyle
340B Program Manager
Bon Secours Mercy Health
4402272762 | 10/14/2022 11:13 AM |
Contacts | Authorizing Official | Insert | New Registration | | Crawford, Michelle L
Market CFO Youngstown
Bon Secours Mercy Health
3307188096 | 10/14/2022 11:13 AM |
Details | Assistance Received From Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Assistance Received To Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Last Recertification Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Grant Number | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | 340B ID | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/14/2022 11:13 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Medicare Provider Number | Insert | New Registration | | 360064 | 10/14/2022 11:13 AM |
Details | Entity Name | Insert | New Registration | | ST. ELIZABETH HEALTH CENTER | 10/14/2022 11:13 AM |
Details | NOFO Number | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | Program Code | Insert | New Registration | | DSH | 10/14/2022 11:13 AM |
Details | Entity Subname | Insert | New Registration | | Youngstown Primary Care | 10/14/2022 11:13 AM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Details | State | Insert | New Registration | | Pending | 10/14/2022 11:13 AM |
Dates | Registration Date | Insert | New Registration | | 10/14/2022 11:13:37 AM | 10/14/2022 11:13 AM |
Dates | Signed By Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Dates | Start Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Terminations | Termination Comments | Insert | New Registration | | | 10/14/2022 11:13 AM |
Terminations | Termination Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/14/2022 11:13 AM |
Terminations | Termination Reason | Insert | New Registration | | | 10/14/2022 11:13 AM |