Covered Entity Details

PED363305-51 NATIONWIDE CHILDREN'S HOSPITAL (Active) - information as of 5/1/2025 11:48:06 PM

Main Details

Name

NATIONWIDE CHILDREN'S HOSPITAL

Subdivision Name

Northern Lights - Northern Lights Primary Care Center

Type

Children's Hospital

Rural

340B ID

PED363305-51

Medicare Provider Number

363305

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/10/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/13/2024

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117

Primary Contact

Nationwide Children's Hospital
Jonathan Labuhn, Director, Pharmacy Finance & Supply Chain
(614) 722-0412

Addresses

Street Address

Northern Lights Shopping Center, 3553 Cleveland Avenue
Columbus, OH 43224

Billing Address

Nationwide Children's Hospital
PO Box 31772
Salt Lake City, UT 84131

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OH	1473276	1134152986,1598290157,1275198780,1679977060

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
PED363305-01	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Westside Primary Care Center	1657 Georgesville Square Drive	COLUMBUS	OH	Active
PED363305-02	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Near East Primary Care Center	1125 EAST MAIN STREET	COLUMBUS	OH	Active
PED363305-03	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Northland Primary Care Center	4560 MORSE CENTRE ROAD	COLUMBUS	OH	Active
PED363305-04	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Whitehall Primary Care Center	561 SOUTH YEARLING ROAD	COLUMBUS	OH	Active
PED363305-05	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER/Adolescent Medicine Clinic East Broad	6435 EAST BROAD STREET	COLUMBUS	OH	Active
PED363305-06	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER/Adolescent Medicine Clinic Dublin	5675 VENTURE DRIVE	DUBLIN	OH	Active
PED363305-07	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME-DOWNTOWN/Adolescent Medicine Clinic	380 Butterfly Gardens Drive	COLUMBUS	OH	Active
PED363305-08	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Eastland Primary Care Center	2599 SOUTH HAMILTON RD	COLUMBUS	OH	Active
PED363305-09	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Hilltop Primary Care Center	2857 WEST BROAD STREET	COLUMBUS	OH	Active
PED363305-10	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Linden Primary Care Center	1390 CLEVELAND AVENUE	COLUMBUS	OH	Active
PED363305-11	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Olentangy Primary Care Center	5070 N High St	COLUMBUS	OH	Active
PED363305-12	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	SOUTH HIGH CENTER FOR PRIMARY CARE / South High Primary Care Center	1405S HIGH ST	COLUMBUS	OH	Active
PED363305-13	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER / Westerville Primary Care Center	433 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Active
PED363305-14	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	DOWNTOWN - CLOSE TO HOME / Teen And Pregnant Clinic	380 Butterfly Gardens Drive	COLUMBUS	OH	Active
PED363305-15	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	SHARON WOODS - PRIMARY CARE CENTER	1777E DUBLIN GRANVILLE RD	COLUMBUS	OH	Active
PED363305-16	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	DOWNTOWN PRIMARY CARE CENTER	380 Butterfly Gardens Drive, Suite 3E/F	Columbus	OH	Active
PED363305-17	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	PRIMARY CARE CLINIC RED	380 Butterfly Gardens Drive, Suite 3E/F	Columbus	OH	Terminated
PED363305-18	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	IMMUNODEFICIENCY CLINIC	380 Butterfly Gardens Dr., Suite 2B	Columbus	OH	Active
PED363305-19	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Rheumatology Clinic Dublin	5675 VENTURE DR	DUBLIN	OH	Active
PED363305-20	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic Westerville	433 N CLEVELAND AVE	WESTERVILLE	OH	Active
PED363305-21	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-22	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic East Broad	6435 E BROAD ST	COLUMBUS	OH	Active
PED363305-23	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	WESTERVILLE SURGERY CENTER - Neurology Clinic Westerville	455 EXECUTIVE CAMPUS DR	WESTERVILLE	OH	Active
PED363305-24	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Dermatology Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-25	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - PULMONARY CLINIC WESTERVILLE	433 N CLEVELAND AVE	WESTERVILLE	OH	Active
PED363305-26	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Neurology Clinic Dublin	5675 VENTURE DR	DUBLIN	OH	Active
PED363305-27	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	BH Psychiatry BHP	444 BUTTERFLY GARDENS DR	COLUMBUS	OH	Active
PED363305-28	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	ENDOCRINOLOGY - ENDOCRINOLOGY CLINIC LAC	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-29	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	GI Clinic Westerville - GI Clinic Westerville	455 Executive Campus Drive	Westerville	OH	Active
PED363305-30	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - GI Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-31	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	LEWIS CENTER CLOSE TO HOME CENTER - HEMATOLOGY/ONCOLOGY INFUSION LEWIS CENTER	7853 PACER DR	DELAWARE	OH	Active
PED363305-32	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	WESTERVILLE SURGERY CENTER - DERMATOLOGY CLINIC WESTERVILLE	455 EXECUTIVE CAMPUS DR	WESTERVILLE	OH	Active
PED363305-33	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Lincoln Village Primary Care Center - Lincoln Village Primary Care Center	4766 W. Broad St	Columbus	OH	Active
PED363305-34	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME-DOWNTOWN/Adolescent Medicine Clinic - BC4Teens	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-35	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Pulmonology Clinic - PULMONARY CLINIC DUBLIN	5665 Venture Drive	Dublin	OH	Active
PED363305-36	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY WESTERVILLE	455 Executive Campus Dr	Westerville	OH	Active
PED363305-37	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY EAST BROAD	6435 East Broad Street	Columbus	OH	Active
PED363305-38	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY CANAL WINCHESTER	7901 Diley Rd.	Canal Winchester	OH	Active
PED363305-39	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY DUBLIN	5675 Venture Drive	Dublin	OH	Active
PED363305-40	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Allergy Clinic - ALLERGY CLINIC HILLIARD	4363 All Seasons Dr	Hilliard	OH	Active
PED363305-41	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Allergy Clinic - ALLERGY CLINIC LEWIS CENTER	7853 Pacer Drive	Delaware	OH	Active
PED363305-42	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Developmental Behavioral Peds - DEVELOPMENTAL BEHAVIORAL PEDIATRICS CLINIC	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-44	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Developmental Behavioral Peds - DEVELOPMENTAL BEHAVIORAL PEDIATRICS CLINIC WESTERVILLE	187 West Schrock Road	Westerville	OH	Active
PED363305-45	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Outpatient Psychiatry - BH PSYCHIATRY 275 SCHROCK RD	275 W. SCHROCK RD.	Westerville	OH	Active
PED363305-46	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Endocrinology Clinic - ENDOCRINOLOGY CLINIC CANAL WINCHESTER	7901 Diley Road Suite 150	Canal Winchester	OH	Active
PED363305-47	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Emergency Dept - Lewis Center - EMERGENCY DEPARTMENT LEWIS CENTER	7853 Pacer Drive	Delaware	OH	Active
PED363305-48	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Child Assessment Center - CHILD ASSESSMENT CENTER	655 E Livingston Avenue	Columbus	OH	Active
PED363305-49	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Dermatology Clinic - DERMATOLOGY CLINIC CANAL WINCHESTER	7901 Diley Road	Canal Winchester	OH	Active
PED363305-50	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Neurology Clinic - NEUROLOGY CLINIC EAST BROAD	6435 East Broad	Columbus	OH	Active
PED363305-51	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Northern Lights - Northern Lights Primary Care Center	Northern Lights Shopping Center, 3553 Cleveland Avenue	Columbus	OH	Active
PED363305-52	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	RHEUMATOLOGY CLINIC - RHEUMATOLOGY CLINIC LOSC	405 Butterfly Gardens Drive	Columbus	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Group Change Request	Nationwide Children's Hospital Pharmacy 700 Children's Drive Columbus, OH 43205	Nationwide Children's Hospital PO Box 31772 Salt Lake City, UT 84131	1/13/2025 4:07 PM
Contacts	Primary Contact	Update	Group Change Request	Skelton, Jasmine 340B Coordinator Nationwide Children's Hospital 6147225799	Labuhn, Jonathan Director, Pharmacy Finance & Supply Chain Nationwide Children's Hospital 6147220412	10/1/2024 10:02 AM
Details	Last Recertification Date	Update	Recertification		8/19/2024 11:25:24 AM	8/19/2024 11:25 AM
Addresses	Billing Address	Insert	Group Change Request		Nationwide Children's Hospital Pharmacy 700 Children's Drive Columbus, OH 43205	7/18/2024 10:52 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Brown, Luke Vice President of Finance and Treasury Nationwide Childrens Hospital 6143553117	2/13/2024 10:44 AM
Details	340B ID	Update	New Registration		PED363305-51	2/13/2024 10:44 AM
Details	Entity Name	Update	New Registration	NATIONWIDE CHILDRENS HOSPITAL	NATIONWIDE CHILDREN'S HOSPITAL	2/13/2024 10:44 AM
Details	Entity Subname	Update	New Registration	Northern Lights	Northern Lights - Northern Lights Primary Care Center	2/13/2024 10:44 AM
Dates	Participating Approval Date	Update	New Registration		2/13/2024 10:44:20 AM	2/13/2024 10:44 AM
Details	State	Update	New Registration	Pending	Approved	2/13/2024 10:44 AM
Dates	Signed By Date	Update	New Registration		1/26/2024 10:21:58 AM	2/13/2024 10:44 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/13/2024 10:44 AM
Addresses	Main Address	Insert	New Registration		Northern Lights Shopping Center, 3553 Cleveland Avenue Columbus, OH 43224	1/10/2024 10:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2024 10:30 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1473276	1/10/2024 10:30 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/10/2024 10:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1134152986	1/10/2024 10:30 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/10/2024 10:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598290157	1/10/2024 10:30 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/10/2024 10:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1275198780	1/10/2024 10:30 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/10/2024 10:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679977060	1/10/2024 10:30 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/10/2024 10:30 AM
Contacts	Authorizing Official	Insert	New Registration		Brown, Luke Vice President of Finance and Treasury Nationwide Childrens Hospital 6143553117	1/10/2024 10:30 AM
Contacts	Primary Contact	Insert	New Registration		Skelton, Jasmine 340B Coordinator Nationwide Children's Hospital 6147225799	1/10/2024 10:30 AM
Details	Assistance Received From Date	Insert	New Registration			1/10/2024 10:30 AM
Details	Assistance Received To Date	Insert	New Registration			1/10/2024 10:30 AM
Details	Last Recertification Date	Insert	New Registration			1/10/2024 10:30 AM
Details	Grant Number	Insert	New Registration			1/10/2024 10:30 AM
Details	340B ID	Insert	New Registration			1/10/2024 10:30 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2024 10:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2024 10:30 AM
Details	Medicare Provider Number	Insert	New Registration		363305	1/10/2024 10:30 AM
Details	Entity Name	Insert	New Registration		NATIONWIDE CHILDRENS HOSPITAL	1/10/2024 10:30 AM
Details	NOFO Number	Insert	New Registration			1/10/2024 10:30 AM
Details	Program Code	Insert	New Registration		PED	1/10/2024 10:30 AM
Details	Entity Subname	Insert	New Registration		Northern Lights	1/10/2024 10:30 AM
Dates	Participating Approval Date	Insert	New Registration			1/10/2024 10:30 AM
Details	State	Insert	New Registration		Pending	1/10/2024 10:30 AM
Dates	Registration Date	Insert	New Registration		1/10/2024 10:30:37 AM	1/10/2024 10:30 AM
Dates	Signed By Date	Insert	New Registration			1/10/2024 10:30 AM
Dates	Start Date	Insert	New Registration			1/10/2024 10:30 AM
Terminations	Termination Comments	Insert	New Registration			1/10/2024 10:30 AM
Terminations	Termination Date	Insert	New Registration			1/10/2024 10:30 AM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2024 10:30 AM
Terminations	Termination Reason	Insert	New Registration			1/10/2024 10:30 AM