340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
RRC360180-17 CLEVELAND CLINIC HOSPITAL (Terminated)
Print
Main Details
Name
CLEVELAND CLINIC HOSPITAL
Subdivision Name
Lakewood Community Health Center - BRAIN HEALTH - ASSESSMENT CENTER
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360180-17
Medicare Provider Number
360180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/19/2020
Last Recertification Date
8/29/2023
Termination Date
Termination Reason
10/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Cleveland Clinic Health System
Tim Longville, Chief Accounting Officer and Controller
(216) 636-7416
Primary Contact
Cleveland Clinic
Jonathan Williams, Senior Director of Pharmacy - 340B
(216) 444-8884
Addresses
Street Address
1450 Belle Ave
200
LAKEWOOD, OH 44107
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
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session