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DSH360059C METROHEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
METROHEALTH MEDICAL CENTER
Subdivision Name
METROHEALTH OLD BROOKLYN SENIOR HEALTH & WELLNESS CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360059C
Medicare Provider Number
360059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/13/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/14/2007
Last Recertification Date
8/10/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
MetroHealth System
Michael Stern, SVP, Chief of Staff
(216) 778-5772
Primary Contact
MetroHealth System
Patricia Radatz, Director, Research and Regulatory Compliance
(216) 778-4968
Addresses
Street Address
4229 PEARL RD.
CLEVELAND, OH 44109
Billing Address
METROHEALTH MEDICAL CENTER
2500 METROHEALTH DRIVE
CLEVELAND, OH 44109
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/24/09 SUBDIV NAME UPDATE, ADDED BILL TO AND SHIP TO ADDR; 10/2/07-SUB DIV NAME CHANGE (WAS METROHEALTH SENIOR WELLNESS CENTER). ADDED ROOM NUMBER
06/13/2007
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