Covered Entity Details

RWII43201G EQUITAS HEALTH (Terminated) - information as of 6/17/2025 11:43:40 PM

Main Details

Name

EQUITAS HEALTH

Subdivision Name

Canton Office

Type

Ryan White Part B

340B ID

RWII43201G

Grant Number

X07HA00016

Additional Details

Current Program Status

Terminated

Registration Date

10/14/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/10/2014

Last Recertification Date

2/8/2021

Time Period the Assistance was Received

4/1/2020 - 3/31/2021

Termination Date
Termination Reason

7/1/2021
Business decision by the Covered Entity

Contacts

Authorizing Official

Equitas Health
Nick Saltman, Interim Chief Pharmacy Officer
(614) 987-5621

Primary Contact

Equitas Health
Anna Wuerth, Sr. Director of Grants Implementation and Integration
(614) 340-6754

Addresses

Street Address

400 TUSCARAWAS ST. W
SUITE 405
CANTON, OH 44702

Billing Address

Equitas Health
4400 NORTH HIGH STREET
SUITE 300
COLUMBUS, OH 43214

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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	0379616,0279161,0278439,0318260,0073711,0093981,0204947,0068920,0187342,0237797	1851838478,1518227453,1114287547,1639507106,1538605860,1841737475,1255846515,1811531122,1972097707

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 #2
1222 S Patterson Blvd., Suite 110
Dayton, OH 45402

Shipping Address 3

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

Shipping Address 4

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

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	12/10/2014	01/01/2015	01/01/2016	01/04/2016
Contract Detail	AMC OHIO LLC #2		1222 S. PATTERSON BLVD SUITE 110	DAYTON	OH	45402-2645	12/10/2014	01/01/2015	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	12/10/2014	01/01/2015	03/01/2016	03/08/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	NOFO Number	Update		HRSA-17-036		12/16/2023 10:34 AM
Contacts	Authorizing Official	Update	Contract Pharmacy Change Request	Clark, Aaron Chief Healthcare Operations Officer Equitas Health 6145720890	Saltman, Nick Interim Chief Pharmacy Officer Equitas Health 6149875621	5/17/2022 2:44 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/1/2021 12:00:00 AM	5/7/2021 7:04 AM
Details	State	Update	Termination Request	Active	To Be Terminated	5/7/2021 7:04 AM
Terminations	Termination Comments	Update	Termination Request		This site is currently not being used to purchase medications and therefore we are terminating it.	5/7/2021 7:04 AM
Terminations	Termination Date	Update	Termination Request		7/1/2021 12:00:00 AM	5/7/2021 7:04 AM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2021 12:00:00 AM	5/7/2021 7:04 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	5/7/2021 7:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0279161	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0278439	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0318260	2/8/2021 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972097707	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/8/2021 1:55 PM
Details	Assistance Received From Date	Update	Recertification		4/1/2020 12:00:00 AM	2/8/2021 1:55 PM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	2/8/2021 1:55 PM
Details	Last Recertification Date	Update	Recertification	2/3/2020 3:05:07 PM	2/8/2021 1:55:00 PM	2/8/2021 1:55 PM
Details	NOFO Number	Update	Recertification		HRSA-17-036	2/8/2021 1:55 PM
Contacts	Authorizing Official	Update	Change Request	Anderson, Peggy COO Equitas Health 6143406691	Clark, Aaron Chief Healthcare Operations Officer Equitas Health 6145720890	8/18/2020 7:54 AM
Details	Last Recertification Date	Update	Recertification	2/14/2019 5:44:34 PM	2/3/2020 3:05:07 PM	2/3/2020 3:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/6/2020 9:31 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0379616	1/6/2020 9:31 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	1/6/2020 9:31 PM
Addresses	Shipping Address	Insert	Change Request		AMC Ohio LLC, DBA Equitas Health Pharmacy #4 2805 Gilbert Ave Cincinnati, OH 45206	11/18/2019 1:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811531122	11/18/2019 1:43 PM
Addresses	Shipping Address	Insert	Change Request		AMC Ohio LLC, DBA Equitas Health Pharmacy #3 736 E. Long St. Columbus, OH 43203	4/18/2019 10:52 AM
Addresses	Shipping Address	Delete	Change Request	AMC Ohio LLC, DBA Equitas Health Pharmacy #3 750 E. Long St. Suite 3100 Columbus, OH 43203		4/18/2019 10:52 AM
Details	Last Recertification Date	Update	Recertification	2/17/2018 1:30:20 PM	2/14/2019 5:44:34 PM	2/14/2019 5:44 PM
Addresses	Shipping Address	Insert	Change Request		AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd., Suite 110 Dayton, OH 45402	3/14/2018 10:36 AM
Addresses	Shipping Address	Delete	Change Request	AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd., Suite 110 Dayton, LA 70808		3/14/2018 10:36 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0668920 (OH)		3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0068920	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0187342	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0237797	3/9/2018 4:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/9/2018 4:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1841737475	3/9/2018 4:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255846515	3/9/2018 4:39 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 1:30:20 PM	2/17/2018 1:30 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	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0668920	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0073711	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0093981	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0204947	12/12/2017 9:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/12/2017 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1851838478	12/12/2017 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1518227453	12/12/2017 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1114287547	12/12/2017 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1639507106	12/12/2017 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1538605860	12/12/2017 9:21 AM
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			400 TUSCARAWAS ST. W SUITE 405 CANTON, OH 44702	2/1/2017 11:39 AM
Details	Last Recertification Date	Update		3/2/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 11:39 AM
Addresses	Billing Address	Insert			Equitas Health 4400 NORTH HIGH STREET SUITE 300 COLUMBUS, OH 43214	1/17/2017 7:52 AM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy 1033 N High Street COLUMBUS, OH 43201	1/17/2017 7:52 AM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy #2 1222 S Patterson Blvd., Suite 110 Dayton, LA 70808	1/17/2017 7:52 AM
Addresses	Shipping Address	Insert			AMC Ohio LLC, DBA Equitas Health Pharmacy #3 750 E. Long St. Suite 3100 Columbus, OH 43203	1/17/2017 7:52 AM
Details	Entity Name	Update		AIDS RESOURCE CENTER OHIO, DBA EQUITAS HEALTH	EQUITAS HEALTH	6/2/2016 9:32 AM
Details	Entity Name	Update		AIDS RESOURCE CENTER OHIO	AIDS RESOURCE CENTER OHIO, DBA EQUITAS HEALTH	5/18/2016 11:19 AM
Details	Last Recertification Date	Update		1/30/2015 12:00:00 AM	3/2/2016 12:00:00 AM	3/2/2016 9:48 AM
Details	Last Recertification Date	Update			1/30/2015 12:00:00 AM	1/30/2015 7:25 PM
Details	340B ID	Update		RWII45702	RWII43201G	12/10/2014 1:47 PM
Dates	Participating Approval Date	Update			12/10/2014 12:00:00 AM	12/10/2014 1:47 PM
Details	State	Update		Pending	Active	12/10/2014 1:47 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/10/2014 1:47 PM
Details	Grant Number	Update		T2-OH	X07HA00016	11/26/2014 9:37 AM
Details	340B ID	Update		ONLINE_REG_47228	RWII45702	11/26/2014 9:37 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_47228	10/14/2014 10:11 AM
Details	Last Recertification Date	Insert				10/14/2014 10:11 AM
Details	Grant Number	Insert			T2-OH	10/14/2014 10:11 AM
Details	340B ID	Insert			ONLINE_REG	10/14/2014 10:11 AM
Details	Is Authorizing Official EHB Data	Insert				10/14/2014 10:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2014 10:11 AM
Details	Medicare Provider Number	Insert				10/14/2014 10:11 AM
Details	Entity Name	Insert			AIDS RESOURCE CENTER OHIO	10/14/2014 10:11 AM
Details	Program Code	Insert			RWII	10/14/2014 10:11 AM
Details	Entity Subname	Insert			Canton Office	10/14/2014 10:11 AM
Dates	Participating Approval Date	Insert				10/14/2014 10:11 AM
Details	State	Insert			Pending	10/14/2014 10:11 AM
Dates	Registration Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 10:11 AM
Dates	Signed By Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 10:11 AM
Dates	Start Date	Insert				10/14/2014 10:11 AM
Terminations	Termination Comments	Insert				10/14/2014 10:11 AM
Terminations	Termination Date	Insert				10/14/2014 10:11 AM
Terminations	Termination Effective Date	Insert				10/14/2014 10:11 AM
Terminations	Termination Reason	Insert				10/14/2014 10:11 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History