340B Drug Pricing Program Database
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RRC360070-24 CLEVELAND CLINIC MERCY HOSPITAL (Terminated)
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Main Details
Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
MERCY HEALTH CENTER OF NORTH CANTON - Radiology - MERCY NORTH CANTON MOB NUCLEAR MEDICINE
Type
Rural Referral Center
Rural
Yes
340B ID
RRC360070-24
Medicare Provider Number
360070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/15/2023
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Cleveland Clinic Mercy Hospital
David Stewart, Senior Director of Operations II
(330) 489-1131
Primary Contact
Cleveland Clinic
Jonathan Williams, Senior Director of Pharmacy - 340B
(216) 444-8884
Addresses
Street Address
6200 WHIPPLE AVE NW
NORTH CANTON, OH 44720
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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