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DSH360059GP METROHEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
METROHEALTH MEDICAL CENTER
Subdivision Name
METROHEALTH SYSTEM / OB/GYN J GLEN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360059GP
Medicare Provider Number
360059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/3/2015
Last Recertification Date
9/1/2020
Termination Date
Termination Reason
7/1/2021
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
MetroHealth System
Michael Stern, SVP, Chief of Staff
(216) 778-5772
Primary Contact
MetroHealth System
Brandon Mark Doppelheuer, Finance and Business Manager
(216) 778-8880
Addresses
Street Address
11100 SAINT CLAIR AVE.
J GLEN SMITH HLTH CNTR
CLEVELAND, OH 44108-1943
Billing Address
MetroHealth Medical Center
2500 MetroHealth Drive
Cleveland, OH 44109-1900
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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