Covered Entity Details

DSH360017E GRANT MEDICAL CENTER (Active) - information as of 5/24/2025 12:35:21 AM

Main Details

Name

GRANT MEDICAL CENTER

Subdivision Name

Infusion Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360017E

Medicare Provider Number

360017

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

5/17/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/19/2012

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

OhioHealth
Jean Halpin, President
(614) 566-8952

Primary Contact

OhioHealth
Beth Prier, Director Pharmacy Operations
(614) 566-9249

Addresses

Street Address

303 E. Town St
Columbus, OH 43215

Billing Address

OhioHealth
PO Box 9
Columbus, OH 43216

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	3359253,0419074,0030254	1255377149,1427673185,1699553891

Shipping Addresses

Shipping Address 1

Grant Medical Center
111 South Grant Ave
Columbus, OH 43215

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
Contract Detail	HOMEREACH	DBA OHIOHEALTH INFUSION PHARMACY	404 E WILSON BRIDGE RD STE B	WORTHINGTON	OH	43085-2369	12/04/2012	01/01/2013		06/03/2022	06/03/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH360017A	Child	DSH	GRANT MEDICAL CENTER	CLINIC CONGESTIVE HRT FAILURE	GMC William W Wilkins Professional Building	Columbus	OH	Active
DSH360017AA	Child	DSH	GRANT MEDICAL CENTER	Diagnostics Wilkins - Fluoroscopy	303 East Town Street	Columbus	OH	Active
DSH360017AB	Child	DSH	GRANT MEDICAL CENTER	GMC MAT FET MEDICINE - MAT FET MEDICINE	285 E State St Suite 620	Columbus	OH	Active
DSH360017AC	Child	DSH	GRANT MEDICAL CENTER	GCMH DIAGNOSTICS - DIAGNOSTICS	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AD	Child	DSH	GRANT MEDICAL CENTER	GCMH EMERGENCY DEPT - EMERGENCY DEPT	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AE	Child	DSH	GRANT MEDICAL CENTER	GCMH INTRAOP - INTRAOP	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AF	Child	DSH	GRANT MEDICAL CENTER	GCMH PACU - PACU	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AG	Child	DSH	GRANT MEDICAL CENTER	PMH SHORT STAY - SHORT STAY	1010 Refugee Rd	Pickerington	OH	Active
DSH360017AH	Child	DSH	GRANT MEDICAL CENTER	WMC SHORT STAY - SHORT STAY	260 Polaris Parkway 2nd Floor	Westerville	OH	Active
DSH360017AJ	Child	DSH	GRANT MEDICAL CENTER	GCMH PERIOP - PERIOP	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AK	Child	DSH	GRANT MEDICAL CENTER	GCMH MED SURG ORTHO - SURG ORTHO	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AL	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Med Surg Ortho - Med Surg Ortho	323 East Town St.	Columbus	OH	Active
DSH360017AM	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint PACU - PACU	323 E Town St	Columbus	OH	Active
DSH360017AN	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Ambulatory - Ambulatory Surgery	323 E Town St	Columbus	OH	Active
DSH360017AP	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Anesthesia - Anesthesia	323 E Town St	Columbus	OH	Active
DSH360017AQ	Child	DSH	GRANT MEDICAL CENTER	Radiation Oncology - Radiation Oncology	303 E. Town Street	Columbus	OH	Active
DSH360017AR	Child	DSH	GRANT MEDICAL CENTER	Bone Marrow Transplant Infusion and Apheresis - Infusion	500 Thomas Lane	Columbus	OH	Active
DSH360017AS	Child	DSH	GRANT MEDICAL CENTER	Infusion Center - Bing - Infusion	500 Thomas Lane	Columbus	OH	Active
DSH360017AT	Child	DSH	GRANT MEDICAL CENTER	PMH - Infusion Center	1010 Refugee Road	Pickerington	OH	Active
DSH360017AU	Child	DSH	GRANT MEDICAL CENTER	Cardiac Imaging - Grove City - Cardiac Imaging	1375 Stringtown Road	Grove City	OH	Active
DSH360017AV	Child	DSH	GRANT MEDICAL CENTER	CT Scan - Grove City - CT Scan - Grove City	1375 Stringtown Road	Grove City	OH	Active
DSH360017AW	Child	DSH	GRANT MEDICAL CENTER	PMH - Ultrasound - PMH - Ultrasound	1010 Refugee Road	Pickerington	OH	Active
DSH360017AX	Child	DSH	GRANT MEDICAL CENTER	PMH - Respiratory Therapy - PMH - Respiratory Therapy	1010 Refugee Road	Pickerington	OH	Active
DSH360017AY	Child	DSH	GRANT MEDICAL CENTER	PMH - Pre/Post PACU - PMH - Pre/Post PACU	1010 Refugee Road	Pickerington	OH	Active
DSH360017AZ	Child	DSH	GRANT MEDICAL CENTER	PMH - Neurointerventional Radiology - PMH - Neurointerventional Radiology	1010 Refugee Road	Pickerington	OH	Active
DSH360017B	Child	DSH	GRANT MEDICAL CENTER	BONE & JOINT SURGERY	323 E Town St	Columbus	OH	Active
DSH360017BA	Child	DSH	GRANT MEDICAL CENTER	PMH - MRI - PMH - MRI	1010 Refugee Road	Pickerington	OH	Active
DSH360017BB	Child	DSH	GRANT MEDICAL CENTER	PMH - Labor and Delivery - PMH - Labor and Delivery	1010 Refugee Road	Pickerington	OH	Active
DSH360017BC	Child	DSH	GRANT MEDICAL CENTER	PMH - Surgery Main - PMH - Surgery Main	1010 Refugee Road	Pickerington	OH	Active
DSH360017BD	Child	DSH	GRANT MEDICAL CENTER	PMH - Diagnostics - PMH - Diagnostics	1010 Refugee Road	Pickerington	OH	Active
DSH360017BE	Child	DSH	GRANT MEDICAL CENTER	PMH - CT Scan - PMH - CT Scan	1010 Refugee Road	Pickerington	OH	Active
DSH360017BF	Child	DSH	GRANT MEDICAL CENTER	PMH Cardiac Cath Lab - PMH Cardiac Cath Lab	1010 Refugee Road	Pickerington	OH	Active
DSH360017C	Child	DSH	GRANT MEDICAL CENTER	Adm Day Surgery Outpatient	323 E Town St	Columbus	OH	Active
DSH360017D	Child	DSH	GRANT MEDICAL CENTER	Sleep Lab	285 E State St	Columbus	OH	Terminated
DSH360017E	Child	DSH	GRANT MEDICAL CENTER	Infusion Center	303 E. Town St	Columbus	OH	Active
DSH360017F	Child	DSH	GRANT MEDICAL CENTER	Trauma Clinic	340 E Town St	Columbus	OH	Terminated
DSH360017G	Child	DSH	GRANT MEDICAL CENTER	Arthritis Infusion Center	303 E Town St	Columbus	OH	Active
DSH360017H	Child	DSH	GRANT MEDICAL CENTER	CT Dept Wilkins	285 E Town St	Columbus	OH	Active
DSH360017J	Child	DSH	GRANT MEDICAL CENTER	Mammography Wilkins	285 E State St	Columbus	OH	Active
DSH360017K	Child	DSH	GRANT MEDICAL CENTER	Ultrasound Wilkins	285 E State St	Columbus	OH	Active
DSH360017L	Child	DSH	GRANT MEDICAL CENTER	Wound Care Ctr	285 E State St	Columbus	OH	Active
DSH360017M	Child	DSH	GRANT MEDICAL CENTER	Diagnostics Wilkins	285 E State St	Columbus	OH	Active
DSH360017N	Child	DSH	GRANT MEDICAL CENTER	OHWED EMERGENCY DEPARTMENT	260 Polaris Parkway	Westerville	OH	Active
DSH360017P	Child	DSH	GRANT MEDICAL CENTER	OHWED Pulmonary	300 Polaris Parkway	Westerville	OH	Terminated
DSH360017Q	Child	DSH	GRANT MEDICAL CENTER	OHWED Diagnostics	300 Polaris Parkway	Westerville	OH	Active
DSH360017R	Child	DSH	GRANT MEDICAL CENTER	Westerville Imaging	300 Polaris Parkway	Westerville	OH	Active
DSH360017S	Child	DSH	GRANT MEDICAL CENTER	PMH Emergency Department	1010 Refugee Road	Pickerington	OH	Active
DSH360017T	Child	DSH	GRANT MEDICAL CENTER	PMH - Imaging	1010 Refugee Road	Pickerington	OH	Active
DSH360017U	Child	DSH	GRANT MEDICAL CENTER	Hilliard Emergency Department - Emergency	3880 Fishinger Blvd	Hilliard	OH	Active
DSH360017V	Child	DSH	GRANT MEDICAL CENTER	Obetz Emergency Department - Emergency	4335 Alum Creek Drive	Columbus	OH	Active
DSH360017W	Child	DSH	GRANT MEDICAL CENTER	Powell Emergency Department - Emergency	4141 North Hampton Drive	Powell	OH	Active
DSH360017X	Child	DSH	GRANT MEDICAL CENTER	New Albany Emergency Department - Emergency	5868 North Hamilton Road	New Albany	OH	Active
DSH360017Y	Child	DSH	GRANT MEDICAL CENTER	Reynoldsburg Emergency Department - Emergency	6960 East Main Street	Reynoldsburg	OH	Active
DSH360017Z	Child	DSH	GRANT MEDICAL CENTER	Westerville Cardiac Imaging - Cardiology	260 Polaris Parkway	Westerville	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Mccallister, Brian Director of Finance OhioHealth 6145444154	Halpin, Jean President OhioHealth 6145668952	4/15/2025 9:53 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 4:50:01 PM	9/3/2024 9:50:34 AM	9/3/2024 9:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/7/2024 8:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0030254	4/7/2024 8:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	4/7/2024 8:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1699553891	4/7/2024 8:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	4/7/2024 8:57 PM
Addresses	Main Address	Update	Change Request	285 E. State Street 210 Columbus, OH 43215	303 E. Town St Columbus, OH 43215	9/29/2023 1:05 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:50:57 AM	8/25/2023 4:50:01 PM	8/25/2023 4:50 PM
Contacts	Authorizing Official	Update	Change Request	Bushiri, Gaston VP Finance OhioHealth 6149552002	Mccallister, Brian Director of Finance OhioHealth 6145444154	4/17/2023 10:56 AM
Contacts	Primary Contact	Update	Group Change Request	Smith, Timothy Director of Pharmacy OhioHealth 6145669249	Prier, Beth Director Pharmacy Operations OhioHealth 6145669249	3/27/2023 8:27 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 9:04:11 AM	9/1/2022 10:50:57 AM	9/1/2022 10:50 AM
Addresses	Billing Address	Update	Change Request	Grant Medical Center 111 South Grant Ave Columbus, OH 43215	OhioHealth PO Box 9 Columbus, OH 43216	10/4/2021 12:11 PM
Addresses	Billing Address	Insert	Recertification		Grant Medical Center 111 South Grant Ave Columbus, OH 43215	8/27/2021 9:04 AM
Addresses	Shipping Address	Insert	Recertification		Grant Medical Center 111 South Grant Ave Columbus, OH 43215	8/27/2021 9:04 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 2:22:29 PM	8/27/2021 9:04:11 AM	8/27/2021 9:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2021 9:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0419074	6/14/2021 9:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	6/14/2021 9:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1427673185	6/14/2021 9:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	6/14/2021 9:36 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	9/9/2020 2:22 PM
Details	Last Recertification Date	Update	Recertification	9/8/2019 9:31:43 AM	9/9/2020 2:22:29 PM	9/9/2020 2:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Brandon, Heather VP Finance Grant OhioHealth 6145669340	Bushiri, Gaston VP Finance OhioHealth 6149552002	1/9/2020 9:36 AM
Contacts	Primary Contact	Update	Profile Change Request	Smith, Timothy Pharmacy Site Manager OhioHealth 6145669249	Smith, Timothy Director of Pharmacy OhioHealth 6145669249	10/2/2019 1:35 PM
Contacts	Primary Contact	Update	Recertification	Cook, Jeffrey Director of Pharmacy OhioHealth 6145669054	Smith, Timothy Pharmacy Site Manager OhioHealth 6145669249	9/8/2019 9:31 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 5:06:55 PM	9/8/2019 9:31:43 AM	9/8/2019 9:31 AM
Addresses	Main Address	Update	Change Request	340 E Town St Columbus, OH 43215	285 E. State Street 210 Columbus, OH 43215	6/25/2019 10:46 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 2:36:00 PM	8/21/2018 5:06:55 PM	8/21/2018 5:06 PM
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
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/7/2017 2:36:00 PM	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	Authorizing Official	Update		Brandon, Heather VP Finance Grant 6145669340	Brandon, Heather VP Finance Grant OhioHealth 6145669340	11/7/2017 2:21 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			Brandon, Heather VP Finance Grant 6145669340	3/2/2017 12:57 PM
Contacts	Signed By	Insert			Abel, Joe Controller, Grant Hospital 6145444112	3/2/2017 12:57 PM
Addresses	Main Address	Insert			340 E Town St Columbus, OH 43215	3/2/2017 12:57 PM
Medicaid Billing	NPI: Number	Insert			1255377149	8/29/2016 1:23 PM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 1:23 PM
Details	Last Recertification Date	Update		8/22/2014 12:00:00 AM	8/11/2015 12:00:00 AM	8/11/2015 3:57 PM
Contacts	Primary Contact	Insert			Passafume, Curtis System Vice President for Pharmacy Services 6145335263	6/19/2015 4:54 PM
Details	Last Recertification Date	Update		9/4/2013 2:43:09 PM	8/22/2014 12:00:00 AM	8/22/2014 1:56 PM
Details	Last Recertification Date	Update			9/4/2013 2:43:09 PM	9/4/2013 2:43 PM
Details	340B ID	Update		IS-DSH360017E	DSH360017E	6/19/2012 10:40 AM
Dates	Participating Approval Date	Update			6/19/2012 12:00:00 AM	6/19/2012 10:40 AM
Details	State	Update		Pending	Active	6/19/2012 10:40 AM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/19/2012 10:40 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DSH360017E	6/6/2012 9:08 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/17/2012 3:32 PM
Medicaid Billing	Medicaid: Number	Insert			3359253	5/17/2012 3:32 PM
Medicaid Billing	Medicaid: State	Insert			OH	5/17/2012 3:32 PM
Details	Last Recertification Date	Insert				5/17/2012 3:32 PM
Details	Grant Number	Insert				5/17/2012 3:32 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	5/17/2012 3:32 PM
Details	Is Authorizing Official EHB Data	Insert				5/17/2012 3:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/17/2012 3:32 PM
Details	Medicare Provider Number	Insert			360017	5/17/2012 3:32 PM
Details	Entity Name	Insert			GRANT MEDICAL CENTER	5/17/2012 3:32 PM
Details	Program Code	Insert			DSH	5/17/2012 3:32 PM
Details	Entity Subname	Insert			Infusion Center	5/17/2012 3:32 PM
Dates	Participating Approval Date	Insert				5/17/2012 3:32 PM
Details	State	Insert			Pending	5/17/2012 3:32 PM
Dates	Registration Date	Insert			5/17/2012 12:00:00 AM	5/17/2012 3:32 PM
Dates	Signed By Date	Insert			5/17/2012 12:00:00 AM	5/17/2012 3:32 PM
Dates	Start Date	Insert				5/17/2012 3:32 PM
Terminations	Termination Comments	Insert				5/17/2012 3:32 PM
Terminations	Termination Date	Insert				5/17/2012 3:32 PM
Terminations	Termination Effective Date	Insert				5/17/2012 3:32 PM
Terminations	Termination Reason	Insert				5/17/2012 3:32 PM