340B Drug Pricing Program Database

Name

CLEVELAND CLINIC HOSPITAL

Subdivision Name

Stephanie Tubbs Jones Health Center - NEPHROLOGY - MC HCHC NEPHROLOGY-OPA

Type

Rural Referral Center

Rural

Yes

340B ID

RRC360180-377

Medicare Provider Number

360180

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

1/13/2021

Participating Start Date

4/1/2021

Participating Approval Date

1/27/2021

Last Recertification Date

9/1/2022

Termination Date
Termination Reason

1/1/2023
Hospital Outpatient facility no longer eligible

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

Street Address

13944 Euclid Ave
HH2-1
EAST CLEVELAND, OH 44112

Billing Address

Cleveland Clinic
6801 Brecksville Road
Mail Code: RK1-25
Suite 20
Independence, OH 44131