340B Drug Pricing Program Database
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DSH360059SH METROHEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
METROHEALTH MEDICAL CENTER
Subdivision Name
METROHEALTH SYSTEM BRECKSVILLE - RADIOLOGY BRECKSVILLE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360059SH
Medicare Provider Number
360059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/20/2018
Last Recertification Date
9/2/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
The MetroHealth System
Nicholas R Sukalac, SVP System Services
(216) 778-7757
Primary Contact
MetroHealth System
Brandon Mark Doppelheuer, Finance and Business Manager
(216) 778-8880
Addresses
Street Address
9200 TREEWORTH BLVD
BRECKSVILLE, OH 44141-2591
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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