Covered Entity Details

DSH360159X ADENA REGIONAL MEDICAL CENTER (Active) - information as of 4/29/2025 11:54:07 PM

Main Details

Name

ADENA REGIONAL MEDICAL CENTER

Subdivision Name

Adena Chillicothe Family Physicians

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360159X

Medicare Provider Number

360159

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/17/2015

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Adena Health System
Katherine Edrington, Chief Operations Officer
(740) 779-7282

Primary Contact

Adena Health System
Fred Yingling, Director of Pharmacy
(740) 779-7648

Addresses

Street Address

60 Capital Drive
Chillicothe, OH 45601

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	1475685	1235468083,1902839673

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
DSH360159A	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA CANCER CENTER	4435 SR 159	CHILLICOTHE	OH	Active
DSH360159AA	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Internal Medicine	4439 St. Rt. 159	Chillicothe	OH	Terminated
DSH360159AB	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Occupational Health	4457 State Route 159	Chillicothe	OH	Active
DSH360159AC	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Family Medicine Oak Hill	315 Washington Street	Oak Hill	OH	Terminated
DSH360159AD	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Interventional Pain Management	4437 St. Rt. 159, Suite G15	Chillicothe	OH	Terminated
DSH360159AE	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA RHEUMATOLOGY - Rheumatology	4437 STATE ROUTE 159	CHILLICOTHE	OH	Terminated
DSH360159AF	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Counseling Center - Counseling Center	455 Shawnee Lane	Chillicothe	OH	Active
DSH360159AG	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA SURGERY CENTER - Outpatient Surgery Center	4437 STATE ROUTE 159	CHILLICOTHE	OH	Terminated
DSH360159AH	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA HEALTH CENTER - WOODLANDS - Family Medicine Clinic	311 CALDWELL ST	CHILLICOTHE	OH	Active
DSH360159AJ	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA FAMILY MEDICINE MAIN CAMPUS C - Family Medicine Residency Clinic	4461 STATE ROUTE 159	CHILLICOTHE	OH	Active
DSH360159B	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA URGENT CARE - WESTERN	55 CENTENNIAL BOULEVARD	CHILLICOTHE	OH	Terminated
DSH360159D	Child	DSH	ADENA REGIONAL MEDICAL CENTER	ADENA URGENT CARE - WAVERLY	12340 ST RT 104	WAVERLY	OH	Terminated
DSH360159E	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Family Medicine Washington C.H.	308 Highland Avenue, Suite C	Washington C.H.	OH	Active
DSH360159F	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Endocrinology and Diabetes Care	4439 St. Rt. 159, Suite 150	Chillicothe	OH	Terminated
DSH360159G	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Surgical	4439 St. Rt. 159, Suite 270	Chillicothe	OH	Terminated
DSH360159H	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Pickaway Ross Family Physicians	100 North Walnut	Chillicothe	OH	Active
DSH360159J	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Cardiothoracic & Vascular	4437 St. Rt. 159, Suite 115	Chillicothe	OH	Terminated
DSH360159K	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Cardiology	4437 St. Rt. 159, Suite 125	Chillicothe	OH	Terminated
DSH360159L	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Bone and Joint Center	4437 St. Rt. 159, Suite G15	Chillicothe	OH	Terminated
DSH360159M	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Gastroenterology	4439 St. Rt. 159, Suite 210	Chillicothe	OH	Terminated
DSH360159N	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Urology	4439 St. Rt. 159, Suite 260	Chillicothe	OH	Terminated
DSH360159P	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Pediatrics	4439 St. Rt. 159, Suite G10	Chillicothe	OH	Terminated
DSH360159Q	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Dermatology	4437 St. Rt. 159, Suite G15	Chillicothe	OH	Terminated
DSH360159R	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Pulmonology Critical Care & Sleep Associates	4439 St. Rt. 159, Suite 210	Chillicothe	OH	Terminated
DSH360159S	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Family Medicine Jackson	1000 Veterans Drive	Jackson	OH	Active
DSH360159T	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena ENT and Allergy	4439 St. Rt. 159, Suite G70	Chillicothe	OH	Terminated
DSH360159U	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Family Medicine of Chillicothe	626 Central Center	Chillicothe	OH	Terminated
DSH360159V	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena OB/GYN	4439 St. Rt. 159, Suite 120	Chillicothe	OH	Terminated
DSH360159W	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Family Medicine Circleville	140 Morris Road	Circleville	OH	Active
DSH360159X	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Chillicothe Family Physicians	60 Capital Drive	Chillicothe	OH	Active
DSH360159Y	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Infectious Disease	4439 St. Rt. 159 Suite 150	Chillicothe	OH	Terminated
DSH360159Z	Child	DSH	ADENA REGIONAL MEDICAL CENTER	Adena Nephrology	4437 St. Rt. 159, Suite G35	Chillicothe	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 2:29:16 PM	8/20/2024 2:57:16 PM	8/20/2024 2:57 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 4:25:30 PM	8/28/2023 2:29:16 PM	8/28/2023 2:29 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 12:14:39 PM	8/31/2022 4:25:30 PM	8/31/2022 4:25 PM
Contacts	Authorizing Official	Update	Change Request	Carlson, Lisa Marie CFO Adena Health System 7407797582	Edrington, Katherine Chief Operations Officer Adena Health System 7407797282	4/8/2022 1:22 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 4:47:32 PM	8/27/2021 12:14:39 PM	8/27/2021 12:14 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1902839673 ( )		9/3/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235468083	9/3/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902839673	9/3/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/30/2019 10:27:17 AM	9/3/2020 4:47:32 PM	9/3/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902839673	8/30/2019 10:27 AM
Details	Last Recertification Date	Update	Recertification	9/10/2018 10:12:49 AM	8/30/2019 10:27:17 AM	8/30/2019 10:27 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 2:26:35 PM	9/10/2018 10:12:49 AM	9/10/2018 10:12 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/6/2017 2:26:35 PM	11/6/2017 2:26 PM
Contacts	Authorizing Official	Update		Carlson, Lisa CFO 7407797582	Carlson, Lisa Marie CFO Adena Health System 7407797582	10/5/2017 4:05 PM
Contacts	Primary Contact	Update		Yingling, Fred Director of Pharmacy 7407797648	Yingling, Fred Director of Pharmacy Adena Health System 7407797648	10/4/2017 1:15 PM
Contacts	Primary Contact	Update		Henson, Judith CNO 7407797151	Yingling, Fred Director of Pharmacy 7407797648	8/2/2017 2:03 PM
Contacts	Authorizing Official	Insert			Carlson, Lisa CFO 7407797582	8/2/2017 2:03 PM
Contacts	Signed By	Insert			Rosenberger, Robert M. CFO 7407797582	8/2/2017 2:03 PM
Addresses	Main Address	Insert			60 Capital Drive Chillicothe, OH 45601	8/2/2017 2:01 PM
Details	Last Recertification Date	Update			9/1/2016 12:00:00 AM	9/1/2016 10:22 AM
Contacts	Primary Contact	Insert			Henson, Judith CNO 7407797151	1/28/2016 3:10 PM
Dates	Participating Approval Date	Update			7/17/2015 12:00:00 AM	7/17/2015 2:45 PM
Details	State	Update		Pending	Active	7/17/2015 2:45 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/17/2015 2:45 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_52752	DSH360159X	7/17/2015 1:01 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_52752	7/9/2015 10:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/9/2015 10:26 AM
Medicaid Billing	Medicaid: Number	Insert			1475685	7/9/2015 10:26 AM
Medicaid Billing	Medicaid: State	Insert			OH	7/9/2015 10:26 AM
Details	Last Recertification Date	Insert				7/9/2015 10:26 AM
Details	Grant Number	Insert				7/9/2015 10:26 AM
Details	340B ID	Insert				7/9/2015 10:26 AM
Details	Is Authorizing Official EHB Data	Insert				7/9/2015 10:26 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/9/2015 10:26 AM
Details	Medicare Provider Number	Insert			360159	7/9/2015 10:26 AM
Details	Entity Name	Insert			ADENA REGIONAL MEDICAL CENTER	7/9/2015 10:26 AM
Details	Program Code	Insert			DSH	7/9/2015 10:26 AM
Details	Entity Subname	Insert			Adena Chillicothe Family Physicians	7/9/2015 10:26 AM
Dates	Participating Approval Date	Insert				7/9/2015 10:26 AM
Details	State	Insert			Pending	7/9/2015 10:26 AM
Dates	Registration Date	Insert			7/9/2015 12:00:00 AM	7/9/2015 10:26 AM
Dates	Signed By Date	Insert			7/9/2015 12:00:00 AM	7/9/2015 10:26 AM
Dates	Start Date	Insert				7/9/2015 10:26 AM
Terminations	Termination Comments	Insert				7/9/2015 10:26 AM
Terminations	Termination Date	Insert				7/9/2015 10:26 AM
Terminations	Termination Effective Date	Insert				7/9/2015 10:26 AM
Terminations	Termination Reason	Insert				7/9/2015 10:26 AM