340B Drug Pricing Program Database
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RRC360180-312 CLEVELAND CLINIC HOSPITAL (Terminated)
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Main Details
Name
CLEVELAND CLINIC HOSPITAL
Subdivision Name
Lorain Family Health Center - PEDIATRIC CARDIOLOGY - LORAIN-PED CARDIOLOGY-OPA
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360180-312
Medicare Provider Number
360180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/17/2020
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
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
5700 Cooper Foster Park Rd
LN20
LORAIN, OH 44053
Billing Address
Cleveland Clinic
6801 Brecksville Road
Mail Code: RK1-25
Independence, OH 44131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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