Covered Entity Details

DSH360039AJ GENESIS HEALTHCARE SYSTEM (Approved) - information as of 5/11/2025 11:49:38 PM

Main Details

Name

GENESIS HEALTHCARE SYSTEM

Subdivision Name

Genesis Coshocton Specialty Center - Specialty Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360039AJ

Medicare Provider Number

360039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/30/2025

Last Recertification Date

Contacts

Authorizing Official

Genesis Healthcare System
Michael Norman, Chief Financial Officer
(740) 454-4773

Primary Contact

Genesis Healthcare System
Shona Carr, Pharmacy 340b Manager
(740) 455-4900

Addresses

Street Address

646 Chestnut Street
Coshocton, OH 43812

Billing Address

Genesis HealthCare System
4051 Northpointe Drive
Building 7
Zanesville, OH 43701

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	364430	1598868655
AL	116635	1598868655
AR	238634105	1598868655
AZ	477040	1598868655
CO	41583876	1598868655
FL	910044000	1598868655
GA	003181136A	1598868655
IL	311480941001	1598868655
IN	300039444	1598868655
KY	7100442710	1598868655
LA	2481932	1598868655
MA	110162211A,110162211B	1598868655
MD	546125100	1598868655
MI	1598868655	1598868655
NC	1598868655	1598868655
NE	10026581400	1598868655
OR	500617199	1598868655
PA	1024111890001,1024111890002	1598868655
TN	1516484	1598868655
VA	1598868655	1598868655
WA	1598868655	1598868655
WV	1598868655	1598868655

Shipping Addresses

Shipping Address 1

Genesis Coshocton Medical Center
48439 Genesis Drive
Coshocton, OH 43812

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
DSH360039A	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS HOSPITAL	2951 MAPLE AVE.	ZANESVILLE	OH	Terminated
DSH360039AA	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Coshocton Pulmonary Function and Respiratory Therapy - Pulmonary and Respiratory	48439 Genesis Drive	Coshocton	OH	Active
DSH360039AB	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS COSHOCTON SURGERY CENTER - Surgery	48439 GENESIS DR	COSHOCTON	OH	Active
DSH360039AC	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS COSHOCTON IMAGING & STRESS - Imaging and Stress	48439 GENESIS DR	COSHOCTON	OH	Active
DSH360039AD	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS COSHOCTON OUTPATIENT SERVIC - Clinical Decision Unit	48439 GENESIS DR	COSHOCTON	OH	Active
DSH360039AE	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS COSHOCTON MEDICAL CENTER - Emergency Medical Center	48439 GENESIS DR	COSHOCTON	OH	Active
DSH360039AF	Child	DSH	GENESIS HEALTHCARE SYSTEM	Black Lung Clinic - Black Lung	945 Bethesda Drive	Zanesville	OH	Approved
DSH360039AG	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - 6801 HP Radiology/Bone Density	2800 Maple Avenue	Zanesville	OH	Approved
DSH360039AH	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - 6831 HP Ultrasound	2800 Maple Avenue	Zanesville	OH	Approved
DSH360039AJ	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Coshocton Specialty Center - Specialty Center	646 Chestnut Street	Coshocton	OH	Approved
DSH360039AK	Child	DSH	GENESIS HEALTHCARE SYSTEM	Respiratory Therapy - 6790 Genesis Perry County Respiratory Therapy	301 Dr. Mike Clouse Drive	Somerset	OH	Approved
DSH360039AL	Child	DSH	GENESIS HEALTHCARE SYSTEM	Endocrinology - 6926 Endocrinology - Cambridge	61353 Southgate Road	Cambridge	OH	Approved
DSH360039AM	Child	DSH	GENESIS HEALTHCARE SYSTEM	Cardiovascular Clinic - 6721 Heart & Vascular Center - Cambridge	61353 Southgate Parkway	Camrbridge	OH	Approved
DSH360039AN	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - 6850 HP Mammography	2800 Maple Avenue	Zanesville	OH	Approved
DSH360039AP	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - Perry County Imaging Services	301 Dr. Mike Clouse Drive	Somerset	OH	Approved
DSH360039AQ	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - 6829 HP MRI	2800 Maple Avenue	Zanesville	OH	Approved
DSH360039AR	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Coshocton Medical Center Respiratory Therapy - 9990 GCMC Respiratory Therapy	48439 Genesis Drive	Coshocton	OH	Approved
DSH360039AS	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Imaging Services - 6841 Healthplex CT	2800 Maple Avenue	Zanesville	OH	Approved
DSH360039AT	Child	DSH	GENESIS HEALTHCARE SYSTEM	Cardiovascular Clinic - 6780 Perry County Function Testing	301 Dr. Mike Clouse Drive	Somerset	OH	Approved
DSH360039AU	Child	DSH	GENESIS HEALTHCARE SYSTEM	Respiratory Therapy - 6785 Genesis Perry County Pulmonary Function Testing	301 Dr. Mike Clouse Drive	Somerset	OH	Approved
DSH360039AV	Child	DSH	GENESIS HEALTHCARE SYSTEM	Lung Clinic - 6709 Genesis Lung Center-Cambridge	61353 Southgate Parkway	Cambridge	OH	Approved
DSH360039B	Child	DSH	GENESIS HEALTHCARE SYSTEM	GOOD SAMARITAN HOSPITAL	800 FOREST AVE.	ZANESVILLE	OH	Terminated
DSH360039C	Child	DSH	GENESIS HEALTHCARE SYSTEM	FIRST CARE SOUTH GENESIS HEALTHCARE	23 MAYSVILLE AVE.	ZANESVILLE	OH	Terminated
DSH360039D	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS HEALTH CENTER NEW CONCORD	1 EAST MAIN ST.	NEW CONCORD	OH	Terminated
DSH360039E	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS HEALTHCARE FIRST CARE NORTH	2800 MAPLE AVE.	ZANESVILLE	OH	Terminated
DSH360039F	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS SURGERY CENTER	2907 Bell Street	ZANESVILLE	OH	Active
DSH360039G	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Lung Center	945 Bethesda Drive	ZANESVILLE	OH	Active
DSH360039H	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Cancer Care Center	2951 Maple Ave	Zanesville	OH	Active
DSH360039J	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Interventional Pain	2945 MAPLE AVE.	ZANESVILLE	OH	Active
DSH360039K	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS EMERGENCY & TRAUMA SERVICES	800 FOREST AVENUE	ZANESVILLE	OH	Terminated
DSH360039L	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS ANTICOAGULATION CLINIC	751 FOREST AVENUE	ZANESVILLE	OH	Active
DSH360039M	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS WOUND CARE CENTER	945 BETHESDA DRIVE	ZANESVILLE	OH	Terminated
DSH360039N	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS PERIOPERATIVE SERVICES	800 FOREST AVENUE	ZANESVILLE	OH	Terminated
DSH360039P	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS PERIOPERATIVE SERVICES	2951 MAPLE AVE	ZANESVILLE	OH	Active
DSH360039Q	Child	DSH	GENESIS HEALTHCARE SYSTEM	Good Samaritan Hospital / CARDIOVASCULAR CLINIC	800 FOREST AVE	ZANESVILLE	OH	Terminated
DSH360039R	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS RHEUMATOLOGY CARE CENTER	2525 MAPLE AVE	ZANESVILLE	OH	Active
DSH360039S	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS ENDOCRINOLOGY	860 Bethesda DR	ZANESVILLE	OH	Active
DSH360039T	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Perry County Medical Center	301 MIKE CLOUSE DR	SOMERSET	OH	Active
DSH360039U	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Vein Clinic - Vein Clinic	930 Bethesda Dr	Zanesville	OH	Active
DSH360039V	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS HEART & VASCULAR DIAGNOSTIC - Heart & Vascular Diagnostics	955 BETHESDA DR	ZANESVILLE	OH	Active
DSH360039W	Child	DSH	GENESIS HEALTHCARE SYSTEM	GENESIS INFECTIOUS DISEASE CLINIC - Infectious Disease	945 BETHESDA DR	ZANESVILLE	OH	Active
DSH360039X	Child	DSH	GENESIS HEALTHCARE SYSTEM	CAMBRIDGE SPECIALTY CENTER - Rheumatology Endocrinology	61353 Southgate Rd	CAMBRIDGE	OH	Active
DSH360039Y	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Radiology Diagnostic - PET Scan	2800 Maple Avenue	Zanesville	OH	Active
DSH360039Z	Child	DSH	GENESIS HEALTHCARE SYSTEM	Genesis Coshocton Heart Vascular Diagnostics - Heart Vascular Diagnostics	48439 Genesis Drive	Coshocton	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Norman, Michael Chief Financial Officer Genesis Healthcare System 7404544773	4/30/2025 2:44 PM
Details	340B ID	Update	New Registration		DSH360039AJ	4/30/2025 2:44 PM
Details	Entity Subname	Update	New Registration	Genesis Coshocton Specialty Center	Genesis Coshocton Specialty Center - Specialty Center	4/30/2025 2:44 PM
Dates	Participating Approval Date	Update	New Registration		4/30/2025 2:44:54 PM	4/30/2025 2:44 PM
Details	State	Update	New Registration	Pending	Approved	4/30/2025 2:44 PM
Dates	Signed By Date	Update	New Registration		4/14/2025 4:34:04 PM	4/30/2025 2:44 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/30/2025 2:44 PM
Addresses	Main Address	Insert	New Registration		646 Chestnut Street Coshocton, OH 43812	4/14/2025 8:44 AM
Addresses	Billing Address	Insert	New Registration		Genesis HealthCare System 4051 Northpointe Drive Building 7 Zanesville, OH 43701	4/14/2025 8:44 AM
Addresses	Shipping Address	Insert	New Registration		Genesis Coshocton Medical Center 48439 Genesis Drive Coshocton, OH 43812	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		364430	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		116635	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		238634105	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		477040	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		41583876	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		910044000	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		003181136A	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		311480941001	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		300039444	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100442710	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2481932	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110162211A	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110162211B	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		546125100	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10026581400	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NE	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		500617199	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1024111890001	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1024111890002	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1516484	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		CO	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		GA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		IN	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		MA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		MD	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		NC	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		NE	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		OR	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		TN	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		VA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	4/14/2025 8:44 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1598868655	4/14/2025 8:44 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	4/14/2025 8:44 AM
Contacts	Primary Contact	Insert	New Registration		Carr, Shona Pharmacy 340b Manager Genesis Healthcare System 7404554900	4/14/2025 8:44 AM
Contacts	Authorizing Official	Insert	New Registration		Norman, Michael Chief Financial Officer Genesis Healthcare System 7404544773	4/14/2025 8:44 AM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 8:44 AM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 8:44 AM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 8:44 AM
Details	Grant Number	Insert	New Registration			4/14/2025 8:44 AM
Details	340B ID	Insert	New Registration			4/14/2025 8:44 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 8:44 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 8:44 AM
Details	Medicare Provider Number	Insert	New Registration		360039	4/14/2025 8:44 AM
Details	Entity Name	Insert	New Registration		GENESIS HEALTHCARE SYSTEM	4/14/2025 8:44 AM
Details	NOFO Number	Insert	New Registration			4/14/2025 8:44 AM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 8:44 AM
Details	Entity Subname	Insert	New Registration		Genesis Coshocton Specialty Center	4/14/2025 8:44 AM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 8:44 AM
Details	State	Insert	New Registration		Pending	4/14/2025 8:44 AM
Dates	Registration Date	Insert	New Registration		4/14/2025 8:44:09 AM	4/14/2025 8:44 AM
Dates	Signed By Date	Insert	New Registration			4/14/2025 8:44 AM
Dates	Start Date	Insert	New Registration			4/14/2025 8:44 AM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 8:44 AM
Terminations	Termination Date	Insert	New Registration			4/14/2025 8:44 AM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 8:44 AM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 8:44 AM