Covered Entity Details

DSH360133M GRANDVIEW HOSPITAL (Terminated) - information as of 6/14/2025 10:06:15 AM

Main Details

Name

GRANDVIEW HOSPITAL

Subdivision Name

GRANDVIEW BOONSHOFT INFUSION CENTER / Women's Cancer Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360133M

Medicare Provider Number

360133

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/10/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/8/2014

Last Recertification Date

11/6/2017

Termination Date
Termination Reason

10/1/2018
Business decision by the Covered Entity

Contacts

Authorizing Official

Fort Hamilton Hospital/Grandview Medical Center/Southview Medical Center/Sycamore Medical Center
William E Villegas, Regional VP of Finance
(937) 723-3414

Primary Contact

Grandview Hospital
Linda McCall, Director Pharmacy
(937) 723-5816

Addresses

Street Address

3737 SOUTHERN BLVD
KETTERING, OH 45421-1262

Billing Address
Same as Street Address

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	3354525
		1053339507

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
DSH360133AA	Child	DSH	Kettering Health Dayton	Respiratory Therapy 65.00 / Respiratory Care 450040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133AB	Child	DSH	Kettering Health Dayton	Laboratory 60.00 / Lab 401040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133AC	Child	DSH	Kettering Health Dayton	Radioisotope 56.00 / Nuclear Medicine 422040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133AD	Child	DSH	GRANDVIEW HOSPITAL	Recovery Room 51.00 / Preadmitting Testing 385040	1997 Miamisburg Centerville Rd	Dayton	OH	Terminated
DSH360133AE	Child	DSH	Kettering Health Dayton	Recovery Room 51.00 / Post Anesthesia Care Unit 365040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133AF	Child	DSH	Kettering Health Dayton	Operating Room 50.00 / Hand & Ortho 369040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133AG	Child	DSH	Kettering Health Dayton	Operating Room 50.00 / Pain Center 384030	425 W. Grand Ave.	DAYTON	OH	Active
DSH360133AH	Child	DSH	GRANDVIEW HOSPITAL	Recovery Room 51.00/Short Stay 386030 - infusion	405 W. GRAND AVE.	DAYTON	OH	Terminated
DSH360133AJ	Child	DSH	Kettering Health Dayton	Operating Room 50.00 / Pain Center 384040 - KHWT Pain Center	1997 Miamisburg-Centerville Road	Dayton	OH	Active
DSH360133AK	Child	DSH	Kettering Health Dayton	Adults & Pediatrics 30.00 / Maternity 318440	1997 Miamisburg-Centerville Rd	Centerville	OH	Active
DSH360133AL	Child	DSH	Kettering Health Dayton	Intensive Care Unit 31.00 / ICU 340440	1997 Miamisburg-Centerville Rd	Centerville	OH	Active
DSH360133AM	Child	DSH	Kettering Health Dayton	Southview Clinic 90.09 / Southview Women's Center 473240	1989 Miamisburg-Centerville Rd	Centerville	OH	Active
DSH360133AN	Child	DSH	Kettering Health Dayton	Adults & Pediatrics 30.00 / KHWT Med Surg 310440	1997 Miamisburg-Centerville Rd	Centerville	OH	Active
DSH360133AP	Child	DSH	Kettering Health Dayton	Cassano Clinic 90.13 / Cassano-Specialist Services 472330	165 Edwin C Moses Blvd	Dayton	OH	Active
DSH360133AQ	Child	DSH	Kettering Health Dayton	Grandview Medical Ctr Infusion Srvs 90.16 / KHDO - Troy Infusion 323830 - Infusion	600 W. Main St	Troy	OH	Active
DSH360133AR	Child	DSH	Kettering Health Dayton	KCC Clinic 90.19/KCC Clinic 484830 - Oncology	3700 Southern Blvd	Kettering	OH	Active
DSH360133AS	Child	DSH	Kettering Health Dayton	KCC Clinic 90.19 / KHDO Infusion Ctr KCC 2nd 323730	3700 Southern Blvd	Kettering	OH	Active
DSH360133AT	Child	DSH	Kettering Health Dayton	Grandview Medical Infusion Srvs 90.16 / Covid OP Infusion 322930 - infusion	3535 SOUTHERN BLVD	Kettering	OH	Active
DSH360133C	Child	DSH	Kettering Health Dayton	Operating Room 50.00 / Endoscopy 361040	1997 Miamisburg-Centerville Road	Dayton	OH	Active
DSH360133D	Child	DSH	Kettering Health Dayton	Operating Room 50.00/ Operating Room 360040	1997 Miamisburg-Centerville Road	Dayton	OH	Active
DSH360133E	Child	DSH	Kettering Health Dayton	Radiology-Diagnostic 54.00/Radiology 421040	1997 Miamisburg-Centerville Road	Dayton	OH	Active
DSH360133H	Child	DSH	GRANDVIEW HOSPITAL	Boonshoft Infusion Therapy	3737 Southern Blvd	Kettering	OH	Terminated
DSH360133J	Child	DSH	Kettering Health Dayton	Emergency 91.00 / Emergency Room 378040	1997 Miamisburg-Centerville Road	Dayton	OH	Active
DSH360133K	Child	DSH	Kettering Health Dayton	Huber Heights Clinic 90.04/ Emergency Room HH 378033	8701 Old Troy Pike	Huber Heights	OH	Active
DSH360133L	Child	DSH	Kettering Health Dayton	Grandview Medical Ctr Infusion SRVS 90.16 / KHDO - Soin Infusion 324830	3535 PENTAGON BLVD 400	BEAVERCREEK	OH	Active
DSH360133M	Child	DSH	GRANDVIEW HOSPITAL	GRANDVIEW BOONSHOFT INFUSION CENTER / Women's Cancer Center	3737 SOUTHERN BLVD	KETTERING	OH	Terminated
DSH360133N	Child	DSH	Kettering Health Dayton	KCC Clinic 90.19 / KHDO - KCC Infusion 324430	3700 Southern Blvd STE 5107	Kettering	OH	Active
DSH360133P	Child	DSH	Kettering Health Dayton	Grandview Medical Ctr Infusion SRVS 90.16 / KHDO - KHWT Infusion 324440	1989 MIAMISBURG CENTERVILLE RD 101	DAYTON	OH	Active
DSH360133Q	Child	DSH	Kettering Health Dayton	Electrocardiology 69.00 / Diagnostic Cardiology-Yankee 412340	7677 YANKEE STREET	CENTERVILLE	OH	Active
DSH360133R	Child	DSH	Kettering Health Dayton	Electrocardiology 69.00/ Diagnostic Cardiology-Little York 412230	4160 LITTLE YORK RD	DAYTON	OH	Active
DSH360133S	Child	DSH	Kettering Health Dayton	Preble County 90.05 / Emergency Room PC 378034	450 F Washington Jackson Road	Eaton	OH	Active
DSH360133T	Child	DSH	Kettering Health Dayton	CT Scan 75.02 / MRI 426040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133U	Child	DSH	Kettering Health Dayton	CT Scan 75.02 / CT 420040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133V	Child	DSH	Kettering Health Dayton	Ultrasound 75.01 / Ultrasound 415040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133W	Child	DSH	Kettering Health Dayton	Physical Therapy 66.00 / IPTHERAP-OP 437040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133X	Child	DSH	Kettering Health Dayton	Electrocardiology 69.00 / Non-Invasive Cardiology 457040	1997 Miamisburg Centerville Rd	Dayton	OH	Active
DSH360133Y	Child	DSH	GRANDVIEW HOSPITAL	Electrocardiology 69.00 / Heart Catheterization 424040	1997 Miamisburg Centerville Rd	Dayton	OH	Terminated
DSH360133Z	Child	DSH	GRANDVIEW HOSPITAL	Occupational Therapy 67.00 / Occupational Therapy 438040	1997 Miamisburg Centerville Rd	Dayton	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Mewhirter, Michael David VP of Finance, CFO Grandview Medical Center System 9377233414	Villegas, William E Regional VP of Finance Fort Hamilton Hospital/Grandview Medical Center/Southview Medical Center/Sycamore Medical Center 9377233414	6/2/2020 7:42 AM
Contacts	Authorizing Official	Update	AO Change Request	Chanaga, Luis CFO Grandview Hospital 9377233414	Mewhirter, Michael David VP of Finance, CFO Grandview Medical Center System 9377233414	12/18/2018 7:17 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		8/28/2018 12:00:00 AM	8/29/2018 2:51 PM
Details	State	Update	Recertification	Active	To Be Terminated	8/29/2018 2:51 PM
Terminations	Termination Date	Update	Recertification		10/1/2018 12:00:00 AM	8/29/2018 2:51 PM
Terminations	Termination Effective Date	Update	Recertification		8/28/2018 12:00:00 AM	8/29/2018 2:51 PM
Terminations	Termination Reason	Update	Recertification		Business decision by the Covered Entity	8/29/2018 2:51 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/6/2017 3:22:05 PM	11/6/2017 3:22 PM
Contacts	Primary Contact	Update	Recertification	McCall, Linda Director Pharmacy 9377235816	McCall, Linda Director Pharmacy Grandview Hospital 9377235816	11/6/2017 3:19 PM
Contacts	Authorizing Official	Update		Chanaga, Luis CFO 9377233414	Chanaga, Luis CFO Grandview Hospital 9377233414	10/17/2017 11:37 AM
Contacts	Authorizing Official	Update		Chanaga, Luis Vice President for Finance/Operations & CFO 9377233414	Chanaga, Luis CFO 9377233414	9/11/2017 3:29 PM
Contacts	Signed By	Insert			Anderson, Todd VP/CFO 9377233414	7/25/2017 3:28 PM
Contacts	Primary Contact	Insert			McCall, Linda Director Pharmacy 9377235816	4/3/2017 8:36 AM
Contacts	Authorizing Official	Insert			Chanaga, Luis Vice President for Finance/Operations & CFO 9377233414	4/3/2017 8:36 AM
Addresses	Main Address	Insert			3737 SOUTHERN BLVD KETTERING, OH 45421-1262	11/10/2016 4:11 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 4:45 PM
Medicaid Billing	NPI: Number	Insert			1053339507	7/8/2016 10:48 AM
Details	Last Recertification Date	Update			8/25/2015 12:00:00 AM	8/25/2015 10:33 AM
Details	Entity Subname	Update		GRANDVIEW BOONSHOFT INFUSION CENTER	GRANDVIEW BOONSHOFT INFUSION CENTER / Women's Cancer Center	12/8/2014 5:53 PM
Dates	Participating Approval Date	Update			12/8/2014 12:00:00 AM	12/8/2014 5:53 PM
Details	State	Update		Pending	Active	12/8/2014 5:53 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/8/2014 5:53 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_46970	DSH360133M	10/16/2014 1:56 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_46970	10/10/2014 9:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/10/2014 9:22 AM
Medicaid Billing	Medicaid: Number	Insert			3354525	10/10/2014 9:22 AM
Medicaid Billing	Medicaid: State	Insert			OH	10/10/2014 9:22 AM
Details	Last Recertification Date	Insert				10/10/2014 9:22 AM
Details	Grant Number	Insert				10/10/2014 9:22 AM
Details	340B ID	Insert				10/10/2014 9:22 AM
Details	Is Authorizing Official EHB Data	Insert				10/10/2014 9:22 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/10/2014 9:22 AM
Details	Medicare Provider Number	Insert			360133	10/10/2014 9:22 AM
Details	Entity Name	Insert			GRANDVIEW HOSPITAL	10/10/2014 9:22 AM
Details	Program Code	Insert			DSH	10/10/2014 9:22 AM
Details	Entity Subname	Insert			GRANDVIEW BOONSHOFT INFUSION CENTER	10/10/2014 9:22 AM
Dates	Participating Approval Date	Insert				10/10/2014 9:22 AM
Details	State	Insert			Pending	10/10/2014 9:22 AM
Dates	Registration Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 9:22 AM
Dates	Signed By Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 9:22 AM
Dates	Start Date	Insert				10/10/2014 9:22 AM
Terminations	Termination Comments	Insert				10/10/2014 9:22 AM
Terminations	Termination Date	Insert				10/10/2014 9:22 AM
Terminations	Termination Effective Date	Insert				10/10/2014 9:22 AM
Terminations	Termination Reason	Insert				10/10/2014 9:22 AM