| Contacts | Authorizing Official | Update | AO Change Request | Mccallister, Brian
Director of Finance
OhioHealth
6145444154 | Osting, Lindsey
President
OhioHealth Doctors Hospital
6145442059 | 2/18/2025 9:59 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2023 5:00:49 PM | 9/3/2024 10:05:52 AM | 9/3/2024 10:05 AM |
| Addresses | Main Address | Update | Change Request |
5131 Beacon Hill Road, Suite 120
Columbus, OH 43228 |
5131 Beacon Hill Road, Suite 200
Columbus, OH 43228 | 3/11/2024 8:50 AM |
| Details | Last Recertification Date | Update | Recertification | 9/12/2022 8:32:28 AM | 8/25/2023 5:00:49 PM | 8/25/2023 5:00 PM |
| Addresses | Billing Address | Update | Recertification | Doctors Hospital
5100 West Broad Street
Columbus, OH 43228 | OhioHealth
PO Box 9
Columbus, OH 43216 | 9/12/2022 8:32 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2021 11:33:07 AM | 9/12/2022 8:32:28 AM | 9/12/2022 8:32 AM |
| Addresses | Billing Address | Insert | Recertification | | Doctors Hospital
5100 West Broad Street
Columbus, OH 43228 | 8/30/2021 11:33 AM |
| Addresses | Shipping Address | Insert | Recertification | | Doctors Hospital
5100 West Broad Street
Columbus, OH 43228 | 8/30/2021 11:33 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2020 2:59:32 PM | 8/30/2021 11:33:07 AM | 8/30/2021 11:33 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | OH | 9/8/2020 2:59 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2019 1:23:59 PM | 9/8/2020 2:59:32 PM | 9/8/2020 2:59 PM |
| Contacts | Primary Contact | Update | Change Request | Holley, Michele
Regional Pharmacy Director
ohiohealth
6145335264 | Miller, Brigitta
Site Manager - Pharmacy Services
OhioHealth Doctors Hospital
6147885590 | 8/7/2020 2:45 PM |
| Contacts | Authorizing Official | Update | Change Request | Abel, Joe
VP Finance, Doctors Hospital
OhioHealth
6145442062 | Mccallister, Brian
Director of Finance
OhioHealth
6145444154 | 11/19/2019 2:39 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2018 11:28:17 AM | 8/29/2019 1:23:59 PM | 8/29/2019 1:23 PM |
| Contacts | Primary Contact | Update | Change Request | Cook, Jeffrey
Director of Pharmacy
OhioHealth
6145669054 | Holley, Michele
Regional Pharmacy Director
ohiohealth
6145335264 | 9/4/2018 11:40 AM |
| Details | Last Recertification Date | Update | Recertification | 11/13/2017 10:38:02 AM | 8/29/2018 11:28:17 AM | 8/29/2018 11:28 AM |
| Details | Entity Name | Update | Change Request | OHIOHEALTH CORPORATION DBA DOCTORS | OHIOHEALTH CORPORATION DBA DOCTORS HOSPITAL | 5/18/2018 4:14 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1972535052 | 5/18/2018 9:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2016 12:00:00 AM | 11/13/2017 10:38:02 AM | 11/13/2017 10:38 AM |
| Contacts | Authorizing Official | Update | | Abel, Joe
VP Finance, Doctors Hospital
6145442062 | Abel, Joe
VP Finance, Doctors Hospital
OhioHealth
6145442062 | 11/13/2017 10:34 AM |
| Contacts | Primary Contact | Update | Recertification | COOK, JEFFREY
Director of Pharmacy
OhioHealth
6145669054 | Cook, Jeffrey
Director of Pharmacy
OhioHealth
6145669054 | 11/7/2017 2:36 PM |
| Contacts | Primary Contact | Update | Recertification | COOK, JEFFREY
DIRECTOR OF PHARMACY
6145669054 | COOK, JEFFREY
Director of Pharmacy
OhioHealth
6145669054 | 11/7/2017 2:26 PM |
| Contacts | Primary Contact | Update | | Passafume, Curtis
System Vice President for Pharmacy Services
6145335263 | COOK, JEFFREY
DIRECTOR OF PHARMACY
6145669054 | 3/2/2017 1:05 PM |
| Contacts | Authorizing Official | Insert | | | Abel, Joe
VP Finance, Doctors Hospital
6145442062 | 3/2/2017 1:05 PM |
| Addresses | Main Address | Insert | | |
5131 Beacon Hill Road, Suite 120
Columbus, OH 43228 | 3/2/2017 1:05 PM |
| Contacts | Signed By | Insert | | | Hammett, Troy
VP Finance
6145442062 | 3/2/2017 1:05 PM |
| Details | Entity Subname | Update | | OhioHealth Heart & Vascular Physicians | OhioHealth Heart & Vascular Physicians Beacon | 10/21/2016 8:38 AM |
| Details | Last Recertification Date | Update | | 8/17/2015 12:00:00 AM | 8/18/2016 12:00:00 AM | 8/18/2016 10:51 AM |
| Details | Last Recertification Date | Update | | 8/25/2014 12:00:00 AM | 8/17/2015 12:00:00 AM | 8/17/2015 1:13 PM |
| Contacts | Primary Contact | Insert | | | Passafume, Curtis
System Vice President for Pharmacy Services
6145335263 | 6/19/2015 4:54 PM |
| Details | Entity Subname | Update | | PHY-Based Cardiology COCVC | OhioHealth Heart & Vascular Physicians | 6/19/2015 4:54 PM |
| Details | Last Recertification Date | Update | | 9/5/2013 6:26:00 AM | 8/25/2014 12:00:00 AM | 8/25/2014 2:17 PM |
| Details | Last Recertification Date | Update | | | 9/5/2013 6:26:00 AM | 9/5/2013 6:26 AM |
| Details | 340B ID | Update | | IS-DR-DSH360152B | DSH360152B | 6/28/2012 8:29 AM |
| Dates | Participating Approval Date | Update | | | 6/28/2012 12:00:00 AM | 6/28/2012 8:29 AM |
| Details | State | Update | | Pending | Active | 6/28/2012 8:29 AM |
| Dates | Start Date | Update | | | 7/1/2012 12:00:00 AM | 6/28/2012 8:29 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | IS-DR-DSH360152B | 5/24/2012 8:55 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 5/14/2012 10:06 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 2229636 | 5/14/2012 10:06 AM |
| Medicaid Billing | Medicaid: State | Insert | | | OH | 5/14/2012 10:06 AM |
| Details | Last Recertification Date | Insert | | | | 5/14/2012 10:06 AM |
| Details | Grant Number | Insert | | | | 5/14/2012 10:06 AM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 5/14/2012 10:06 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 5/14/2012 10:06 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 5/14/2012 10:06 AM |
| Details | Medicare Provider Number | Insert | | | 360152 | 5/14/2012 10:06 AM |
| Details | Entity Name | Insert | | | OHIOHEALTH CORPORATION DBA DOCTORS | 5/14/2012 10:06 AM |
| Details | Program Code | Insert | | | DSH | 5/14/2012 10:06 AM |
| Details | Entity Subname | Insert | | | PHY-Based Cardiology COCVC | 5/14/2012 10:06 AM |
| Dates | Participating Approval Date | Insert | | | | 5/14/2012 10:06 AM |
| Details | State | Insert | | | Pending | 5/14/2012 10:06 AM |
| Dates | Registration Date | Insert | | | 5/14/2012 12:00:00 AM | 5/14/2012 10:06 AM |
| Dates | Signed By Date | Insert | | | 5/14/2012 12:00:00 AM | 5/14/2012 10:06 AM |
| Dates | Start Date | Insert | | | | 5/14/2012 10:06 AM |
| Terminations | Termination Comments | Insert | | | | 5/14/2012 10:06 AM |
| Terminations | Termination Date | Insert | | | | 5/14/2012 10:06 AM |
| Terminations | Termination Effective Date | Insert | | | | 5/14/2012 10:06 AM |
| Terminations | Termination Reason | Insert | | | | 5/14/2012 10:06 AM |