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DSH360144C SOUTH POINTE HOSPITAL (Terminated)
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Main Details
Name
SOUTH POINTE HOSPITAL
Subdivision Name
Internal Medicine Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360144C
Medicare Provider Number
360144
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2017
Participating Start Date
7/1/2017
Participating Approval Date
6/8/2017
Last Recertification Date
11/10/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Cleveland Clinic South Pointe Hospital
Kris Bennett, Chief Operating Officer
(440) 312-2702
Primary Contact
Cleveland Clinic
Jonathan Williams, Senior Director of Pharmacy - 340B
(216) 444-8884
Addresses
Street Address
20050 Harvard Road
Suite 106
Warrensville Heights, OH 44122
Billing Address
Cleveland Clinic
6801 Brecksville Road
Mail Code: RK1-25
Suite 20
Independence, OH 44131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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