Covered Entity Details

DSH360236Q CLERMONT MERCY HOSPITAL (Active) - information as of 5/29/2025 2:03:15 AM

Main Details

Name

CLERMONT MERCY HOSPITAL

Subdivision Name

MERCY CARE CLINIC - CLERMONT

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360236Q

Medicare Provider Number

360236

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2023

Participating Start Date

1/1/2024

Participating Approval Date

11/3/2023

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

BSMH
Cameron Stockdale, Assistant CFO
(513) 215-0202

Primary Contact

BSMH
Brandon Kyle Cheek, Director of Pharmacy
(513) 732-8670

Addresses

Street Address

3020 Hospital Dr
Suite 230
Batavia, OH 45103

Billing Address

Clermont Mercy Hospital
3000 Hospital Drive
Batavia, OH 45103

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	217447	1568562551

Shipping Addresses

Shipping Address 1

Clermont Mercy Hospital
3000 Hospital Drive
Batavia, OH 45103

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
DSH360236A	Child	DSH	CLERMONT MERCY HOSPITAL	MH-MT. ORAB MEDICAL CENTER	154 Health Partners Cir	Mt. Orab	OH	Active
DSH360236B	Child	DSH	CLERMONT MERCY HOSPITAL	Mt. Orab Medical Center - Laboratory	154 Health Partners Circle	Mt Orab	OH	Terminated
DSH360236C	Child	DSH	CLERMONT MERCY HOSPITAL	Mercy Health - Bethel - Physical Therapy	720 W Plane Street, Suite 110	Bethel	OH	Terminated
DSH360236D	Child	DSH	CLERMONT MERCY HOSPITAL	MH-CLERMONT HOSPITAL WOUND CARE	3020 Hospital Dr	Batavia	OH	Active
DSH360236E	Child	DSH	CLERMONT MERCY HOSPITAL	MH-CLERMONT HOSPITAL WOUND CARE	3020 Hospital Dr	Batavia	OH	Active
DSH360236F	Child	DSH	CLERMONT MERCY HOSPITAL	Eastgate Surgery Center - Endoscopy	4415 Aicholtz Road	Cincinnati	OH	Terminated
DSH360236G	Child	DSH	CLERMONT MERCY HOSPITAL	Eastgate Surgery Center - Outpatient Surgery	4415 Aicholtz Road	Cincinnati	OH	Terminated
DSH360236H	Child	DSH	CLERMONT MERCY HOSPITAL	MH-CLERMONT HOSPITAL ANTICOAG CLIN	3020 Hospital Dr	Batavia	OH	Active
DSH360236J	Child	DSH	CLERMONT MERCY HOSPITAL	MH-MT. ORAB MEDICAL CENTER	154 Health Partners Cir	Mt. Orab	OH	Active
DSH360236K	Child	DSH	CLERMONT MERCY HOSPITAL	MERCY HEALTH - MILFORD IMAGING/LAB	201 OLD BANK RD	MILFORD	OH	Terminated
DSH360236L	Child	DSH	CLERMONT MERCY HOSPITAL	ONCOLOGY SERVICES - INFUSION THERAPY	3000 Hospital Drive	Batavia	OH	Terminated
DSH360236M	Child	DSH	CLERMONT MERCY HOSPITAL	MERCY HEALTH BHI - BEHAVIORAL HEALTH	3000 Hospital Drive	Batavia	OH	Terminated
DSH360236N	Child	DSH	CLERMONT MERCY HOSPITAL	SPECIALIZED SERVICES UNIT - AMBULATORY CARE	3000 Hospital Drive	Batavia	OH	Terminated
DSH360236P	Child	DSH	CLERMONT MERCY HOSPITAL	MERCY HEALTH - INFUSION AND CANCER CARE	4777 E Galbraith	Cincinnati	OH	Active
DSH360236Q	Child	DSH	CLERMONT MERCY HOSPITAL	MERCY CARE CLINIC - CLERMONT	3020 Hospital Dr	Batavia	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Stockdale, Cameron Assistant CFO BSMH 5137357548	Stockdale, Cameron Assistant CFO BSMH 5132150202	5/28/2025 4:30 PM
Contacts	Signed By	Update	Profile Change Request	Harper, Shiley K CFO Clermont 5137357548	Harper, Shiley K CFO BSMH 5132050202	2/13/2025 11:37 AM
Contacts	Authorizing Official	Update	AO Change Request	Harper, Shiley K CFO Clermont 5137357548	Stockdale, Cameron Assistant CFO BSMH 5137357548	11/21/2024 6:32 AM
Addresses	Main Address	Update	Change Request	3020 Hospital Drive 230 Batavia, OH 45103	3020 Hospital Dr Suite 230 Batavia, OH 45103	11/6/2024 11:00 AM
Details	Entity Subname	Update	Change Request	Clermont Mercy Care Clinic - Clinic	MERCY CARE CLINIC - CLERMONT	11/6/2024 11:00 AM
Details	Last Recertification Date	Update	Recertification		8/29/2024 11:20:20 AM	8/29/2024 11:20 AM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Harper, Shiley K CFO Clermont 5137357548	11/3/2023 9:19 AM
Details	340B ID	Update	New Registration		DSH360236Q	11/3/2023 9:19 AM
Details	Entity Subname	Update	New Registration	Clermont Mercy Care Clinic	Clermont Mercy Care Clinic - Clinic	11/3/2023 9:19 AM
Dates	Participating Approval Date	Update	New Registration		11/3/2023 9:19:56 AM	11/3/2023 9:19 AM
Details	State	Update	New Registration	Pending	Approved	11/3/2023 9:19 AM
Dates	Signed By Date	Update	New Registration		10/9/2023 1:04:28 PM	11/3/2023 9:19 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	11/3/2023 9:19 AM
Addresses	Main Address	Insert	New Registration		3020 Hospital Drive 230 Batavia, OH 45103	10/9/2023 1:04 PM
Addresses	Billing Address	Insert	New Registration		Clermont Mercy Hospital 3000 Hospital Drive Batavia, OH 45103	10/9/2023 1:04 PM
Addresses	Shipping Address	Insert	New Registration		Clermont Mercy Hospital 3000 Hospital Drive Batavia, OH 45103	10/9/2023 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		217447	10/9/2023 1:04 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/9/2023 1:04 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568562551	10/9/2023 1:04 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/9/2023 1:04 PM
Contacts	Primary Contact	Insert	New Registration		Cheek, Brandon Kyle Director of Pharmacy BSMH 5137328670	10/9/2023 1:04 PM
Contacts	Authorizing Official	Insert	New Registration		Harper, Shiley K CFO Clermont 5137357548	10/9/2023 1:04 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2023 1:04 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2023 1:04 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2023 1:04 PM
Details	Grant Number	Insert	New Registration			10/9/2023 1:04 PM
Details	340B ID	Insert	New Registration			10/9/2023 1:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2023 1:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2023 1:04 PM
Details	Medicare Provider Number	Insert	New Registration		360236	10/9/2023 1:04 PM
Details	Entity Name	Insert	New Registration		CLERMONT MERCY HOSPITAL	10/9/2023 1:04 PM
Details	NOFO Number	Insert	New Registration			10/9/2023 1:04 PM
Details	Program Code	Insert	New Registration		DSH	10/9/2023 1:04 PM
Details	Entity Subname	Insert	New Registration		Clermont Mercy Care Clinic	10/9/2023 1:04 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2023 1:04 PM
Details	State	Insert	New Registration		Pending	10/9/2023 1:04 PM
Dates	Registration Date	Insert	New Registration		10/9/2023 1:04:23 PM	10/9/2023 1:04 PM
Dates	Signed By Date	Insert	New Registration			10/9/2023 1:04 PM
Dates	Start Date	Insert	New Registration			10/9/2023 1:04 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2023 1:04 PM
Terminations	Termination Date	Insert	New Registration			10/9/2023 1:04 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2023 1:04 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2023 1:04 PM