Covered Entity Details

HV00531 Equitas Health, Inc. (Active) - information as of 5/14/2025 10:48:04 PM

Main Details

Name

Equitas Health, Inc.

Subdivision Name

Equitas Health Short North

Type

Ryan White Part C

340B ID

HV00531

Grant Number

H76HA00531

Additional Details

Current Program Status

Active

Registration Date

10/12/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/9/2012

Last Recertification Date

2/14/2025

Time Period the Assistance was Received

5/1/2022 - 4/30/2025

Contacts

Authorizing Official

Equitas Health
Thomas Nicholas Saltsman, Chief Pharmacy Officer
(614) 987-5621

Primary Contact

Equitas Health
Brandy Wyne, Associate Director of 340B Operations
(614) 572-0891

Addresses

Street Address

1033 NORTH HIGH STREET
COLUMBUS, OH 43201

Billing Address

EQUITAS HEALTH
1105 Schrock Rd
Suite 400
Columbus, OH 43229

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
11/8/12 - Recieved verification from PO and fowarded to IS for approval. 11/8/12 - Reviewed registration and sent verification email to PO.	11/08/2012
11/8/12 - Reviewed registration and sent verification email to PO.	11/08/2012

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	0379616,0021693,0073711,0093981,0204947	1114287547,1639507106,1538605860,1811531122,1447936604
KY	7100660660	1811531122

Shipping Addresses

Shipping Address 1

AMC Ohio LLC, DBA Equitas Health Pharmacy
1033 N High Street
Columbus, OH 43201

Shipping Address 2

AMC Ohio LLC, DBA Equitas Health Pharmacy #3
736 E. Long St.
Columbus, OH 43203

Shipping Address 3

AMC Ohio LLC, DBA Equitas Health Pharmacy #4
2805 Gilbert Ave
Cincinnati, OH 45206

Shipping Address 4

AMC Ohio LLC, DBA Equitas Health Pharmacy #2
1222 S Patterson Blvd.
Suite 110
Dayton, OH 45402

Shipping Address 5

AMC Ohio LLC, DBA Equitas Health Pharmacy #5
636 W. Exchange Street
Akron, OH 44302

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AMC OHIO LLC	1033 N. HIGH STREET		COLUMBUS	OH	43201-2409	03/14/2013	04/01/2013	01/01/2016	01/04/2016
Contract Detail	AMC OHIO LLC #2		1222 S. PATTERSON BLVD SUITE 110	DAYTON	OH	45402-2645	04/07/2014	07/01/2014	01/01/2016	01/04/2016
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	03/13/2013	04/01/2013	03/01/2016	03/08/2016
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/17/2017	07/01/2017	03/26/2018	03/26/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Wyne, Brandy 340B Support Manager Equitas Health 6145720891	Wyne, Brandy Associate Director of 340B Operations Equitas Health 6145720891	3/26/2025 5:31 PM
Details	Last Recertification Date	Update	Recertification	2/9/2024 12:03:44 PM	2/14/2025 4:31:47 PM	2/14/2025 4:31 PM
Addresses	Shipping Address	Insert	Recertification		AMC Ohio LLC, DBA Equitas Health Pharmacy #5 636 W. Exchange Street Akron, OH 44302	2/9/2024 12:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/9/2024 12:03 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0021693	2/9/2024 12:03 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	2/9/2024 12:03 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447936604	2/9/2024 12:03 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	2/9/2024 12:03 PM
Details	Last Recertification Date	Update	Recertification	2/23/2023 4:08:14 PM	2/9/2024 12:03:44 PM	2/9/2024 12:03 PM
Details	NOFO Number	Update		HRSA-22-015		12/16/2023 10:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0278439 (OH)		4/19/2023 4:23 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0068920 (OH)		4/19/2023 4:23 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1518227453 (OH)		4/19/2023 4:23 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1851838478 (OH)		4/19/2023 4:23 PM
Addresses	Shipping Address	Insert	Recertification		AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd. Suite 110 Dayton, OH 45402	2/23/2023 4:08 PM
Addresses	Shipping Address	Delete	Recertification	AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd, Ste 110 Dayton, OH 45402		2/23/2023 4:08 PM
Details	Assistance Received From Date	Update	Recertification	5/1/2018 12:00:00 AM	5/1/2022 12:00:00 AM	2/23/2023 4:08 PM
Details	Assistance Received To Date	Update	Recertification	4/30/2022 12:00:00 AM	4/30/2025 12:00:00 AM	2/23/2023 4:08 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 11:32:37 AM	2/23/2023 4:08:14 PM	2/23/2023 4:08 PM
Details	NOFO Number	Update	Recertification	HRSA-18-005	HRSA-22-015	2/23/2023 4:08 PM
Contacts	Authorizing Official	Update	AO Change Request	Clark, Aaron Chief Healthcare Operations Officer Equitas Health 6145720890	Saltsman, Thomas Nicholas Chief Pharmacy Officer Equitas Health 6149875621	2/27/2022 8:32 AM
Details	Last Recertification Date	Update	Recertification	2/8/2021 10:37:11 AM	2/7/2022 11:32:37 AM	2/7/2022 11:32 AM
Addresses	Billing Address	Update	Change Request	EQUITAS HEALTH 4400 NORTH HIGH STREET SUITE 300 COLUMBUS, OH 43214	EQUITAS HEALTH 1105 Schrock Rd Suite 400 Columbus, OH 43229	10/13/2021 11:36 AM
Addresses	Shipping Address	Delete	Change Request	Equitas Health 1033 N High Street Columbus, OH 43201		6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0318260 (OH)		6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100660660	6/2/2021 12:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0187342 (OH)		6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0237797 (OH)		6/2/2021 12:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0279161 (OH)		6/2/2021 12:43 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437799830 (OH)		6/2/2021 12:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811531122	6/2/2021 12:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	6/2/2021 12:43 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1841737475 (OH)		6/2/2021 12:43 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255846515 (OH)		6/2/2021 12:43 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1972097707 (OH)		6/2/2021 12:43 PM
Contacts	Primary Contact	Update	Change Request	Wuerth, Anna Sr. Director of Grants Implementation and Integration Equitas Health 6143406754	Wyne, Brandy 340B Support Manager Equitas Health 6145720891	6/2/2021 12:43 PM
Details	Assistance Received To Date	Update	Change Request	4/30/2021 12:00:00 AM	4/30/2022 12:00:00 AM	6/2/2021 12:43 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 10:37 AM
Details	Assistance Received From Date	Update	Recertification		5/1/2018 12:00:00 AM	2/8/2021 10:37 AM
Details	Assistance Received To Date	Update	Recertification		4/30/2021 12:00:00 AM	2/8/2021 10:37 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 3:08:27 PM	2/8/2021 10:37:11 AM	2/8/2021 10:37 AM
Details	NOFO Number	Update	Recertification		HRSA-18-005	2/8/2021 10:37 AM
Contacts	Authorizing Official	Update	Change Request	Anderson, Peggy COO Equitas Health 6143406691	Clark, Aaron Chief Healthcare Operations Officer Equitas Health 6145720890	8/13/2020 5:23 PM
Details	Entity Name	Update	Change Request	EQUITAS HEALTH	Equitas Health, Inc.	7/24/2020 8:24 PM
Details	Entity Subname	Update	Change Request		Equitas Health Short North	7/24/2020 8:24 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437799830	2/5/2020 12:11 PM
Details	Last Recertification Date	Update	Recertification	2/14/2019 5:50:43 PM	2/3/2020 3:08:27 PM	2/3/2020 3:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/6/2020 9:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0379616	1/6/2020 9:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	1/6/2020 9:35 PM
Addresses	Shipping Address	Insert	Change Request		AMC Ohio LLC, DBA Equitas Health Pharmacy #4 2805 Gilbert Ave Cincinnati, OH 45206	11/19/2019 9:35 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811531122	11/19/2019 9:35 AM
Addresses	Shipping Address	Delete	Change Request	AMC Ohio LLC, DBA Equitas Health Pharmacy #3 750 E. Long St. Suite 3100 Columbus, OH 43203		4/16/2019 7:49 AM
Details	Last Recertification Date	Update	Recertification	2/17/2018 1:26:15 PM	2/14/2019 5:50:43 PM	2/14/2019 5:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/25/2019 3:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0318260	1/25/2019 3:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	1/25/2019 3:26 PM
Addresses	Shipping Address	Insert	Change Request		AMC Ohio LLC, DBA Equitas Health Pharmacy #3 736 E. Long St. Columbus, OH 43203	1/18/2019 10:10 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/9/2018 6:15 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0278439	8/9/2018 6:15 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	8/9/2018 6:15 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/11/2018 5:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0279161	7/11/2018 5:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	7/11/2018 5:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1972097707	7/11/2018 5:43 PM
Addresses	Shipping Address	Delete	Change Request	Procare Pharmacy Direct, LLC, DBA CVS Caremark 105 Mall Blvd. Monroeville, PA 15146		7/11/2018 8:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0668920 (OH)		3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0068920	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0187342	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0237797	3/9/2018 3:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 3:51 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1841737475	3/9/2018 3:51 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255846515	3/9/2018 3:51 PM
Contacts	Signed By	Update		Anderson, Peggy Chief Operating Officer 6143406691	Anderson, Peggy Chief Operating Officer Equitas Health 6143406691	2/27/2018 11:27 AM
Contacts	Primary Contact	Update	Profile Change Request	Wuerth, Anna Director of Healthcare Operations Equitas Health 6143406754	Wuerth, Anna Sr. Director of Grants Implementation and Integration Equitas Health 6143406754	2/22/2018 10:43 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/17/2018 1:26:15 PM	2/17/2018 1:26 PM
Contacts	Primary Contact	Update	New Registration	Wuerth, Anna Director of Healthcare Operations 6143406754	Wuerth, Anna Director of Healthcare Operations Equitas Health 6143406754	12/13/2017 5:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0668920	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0073711	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0093981	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0204947	12/11/2017 4:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/11/2017 4:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1518227453	12/11/2017 4:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1851838478	12/11/2017 4:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1114287547	12/11/2017 4:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1639507106	12/11/2017 4:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538605860	12/11/2017 4:16 PM
Contacts	Authorizing Official	Update		Anderson, Peggy COO 6143406691	Anderson, Peggy COO Equitas Health 6143406691	11/13/2017 5:13 PM
Contacts	Primary Contact	Insert			Wuerth, Anna Director of Healthcare Operations 6143406754	8/2/2017 2:04 PM
Contacts	Authorizing Official	Insert			Anderson, Peggy COO 6143406691	8/2/2017 2:04 PM
Contacts	Signed By	Insert			Anderson, Peggy Chief Operating Officer 6143406691	8/2/2017 2:04 PM
Addresses	Main Address	Insert			1033 NORTH HIGH STREET COLUMBUS, OH 43201	8/2/2017 2:04 PM
Addresses	Billing Address	Insert			EQUITAS HEALTH 4400 NORTH HIGH STREET SUITE 300 COLUMBUS, OH 43214	8/2/2017 2:04 PM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy 1033 N High Street Columbus, OH 43201	8/2/2017 2:04 PM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd, Ste 110 Dayton, OH 45402	8/2/2017 2:04 PM
Addresses	Shipping Address	Insert			Equitas Health 1033 N High Street Columbus, OH 43201	8/2/2017 2:04 PM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy #3 750 E. Long St. Suite 3100 Columbus, OH 43203	8/2/2017 2:04 PM
Addresses	Shipping Address	Insert			Procare Pharmacy Direct, LLC, DBA CVS Caremark 105 Mall Blvd. Monroeville, PA 15146	8/2/2017 2:04 PM
Details	Last Recertification Date	Update		3/2/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 11:37 AM
Details	Entity Name	Update		AIDS RESOURCE CENTER OHIO, DBA EQUITAS HEALTH	EQUITAS HEALTH	6/2/2016 9:27 AM
Details	Entity Name	Update		AIDS RESOURCE CENTER OHIO	AIDS RESOURCE CENTER OHIO, DBA EQUITAS HEALTH	5/18/2016 11:16 AM
Details	Last Recertification Date	Update		1/29/2015 12:00:00 AM	3/2/2016 12:00:00 AM	3/2/2016 9:45 AM
Details	Last Recertification Date	Update		3/14/2014 12:00:00 AM	1/29/2015 12:00:00 AM	1/29/2015 1:19 PM
Details	Last Recertification Date	Update			3/14/2014 12:00:00 AM	3/14/2014 7:44 AM
Details	340B ID	Update		IS-FF-HV00531	HV00531	11/9/2012 11:13 AM
Dates	Participating Approval Date	Update			11/9/2012 12:00:00 AM	11/9/2012 11:13 AM
Details	State	Update		Pending	Active	11/9/2012 11:13 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/9/2012 11:13 AM
Details	Grant Number	Update			H76HA00531	11/8/2012 4:15 PM
Details	340B ID	Update		FF 11.8.12ONLINE_REG	IS-FF-HV00531	11/8/2012 4:15 PM
Details	Comments Public	Insert			11/8/12 - Recieved verification from PO and fowarded to IS for approval. 11/8/12 - Reviewed registration and sent verification email to PO.	11/8/2012 4:15 PM
Details	340B ID	Update		ONLINE_REG	FF 11.8.12ONLINE_REG	11/8/2012 3:47 PM
Details	Comments Public	Insert			11/8/12 - Reviewed registration and sent verification email to PO.	11/8/2012 3:47 PM
Details	Last Recertification Date	Insert				10/12/2012 3:17 PM
Details	Grant Number	Insert				10/12/2012 3:17 PM
Details	340B ID	Insert			ONLINE_REG	10/12/2012 3:17 PM
Details	Is Authorizing Official EHB Data	Insert				10/12/2012 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2012 3:17 PM
Details	Medicare Provider Number	Insert				10/12/2012 3:17 PM
Details	Entity Name	Insert			AIDS RESOURCE CENTER OHIO	10/12/2012 3:17 PM
Details	Program Code	Insert			HV	10/12/2012 3:17 PM
Details	Entity Subname	Insert				10/12/2012 3:17 PM
Dates	Participating Approval Date	Insert				10/12/2012 3:17 PM
Details	State	Insert			Pending	10/12/2012 3:17 PM
Dates	Registration Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 3:17 PM
Dates	Signed By Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 3:17 PM
Dates	Start Date	Insert				10/12/2012 3:17 PM
Terminations	Termination Comments	Insert				10/12/2012 3:17 PM
Terminations	Termination Date	Insert				10/12/2012 3:17 PM
Terminations	Termination Effective Date	Insert				10/12/2012 3:17 PM
Terminations	Termination Reason	Insert				10/12/2012 3:17 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History