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DSH360059AN METROHEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
METROHEALTH MEDICAL CENTER
Subdivision Name
METROHEALTH BUCKEYE HEALTH CENTER- PEDS (PROF)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360059AN
Medicare Provider Number
360059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2014
Participating Start Date
1/1/2017
Participating Approval Date
2/18/2014
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
1/1/2018
Other
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
2816E 116TH STREET
CLEVELAND, OH 44120
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating 4/1/2014 until terminated effective 1/1/2016, reinstated effective 1/1/2017
12/15/2016
May 2025
May 2025
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