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DSH360059K METROHEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
METROHEALTH MEDICAL CENTER
Subdivision Name
J. GLEN SMITH HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360059K
Medicare Provider Number
360059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/16/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/18/2009
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
11100 ST. CLAIR AVENUE
CLEVELAND, OH 44108
Billing Address
METROHEALTH MEDICAL CENTER
2500 METROHEALTH DRIVE
CLEVELAND, OH 44109
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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