Covered Entity Details

PED363305-15 NATIONWIDE CHILDREN'S HOSPITAL (Active) - information as of 4/29/2025 12:35:50 AM

Main Details

Name

NATIONWIDE CHILDREN'S HOSPITAL

Subdivision Name

SHARON WOODS - PRIMARY CARE CENTER

Type

Children's Hospital

Rural

340B ID

PED363305-15

Medicare Provider Number

363305

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/6/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/24/2015

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117

Primary Contact

Nationwide Children's Hospital
Jonathan Labuhn, Director, Pharmacy Finance & Supply Chain
(614) 722-0412

Addresses

Street Address

1777E DUBLIN GRANVILLE RD
COLUMBUS, OH 43229-3502

Billing Address

Nationwide Children's Hospital
PO Box 31772
Salt Lake City, UT 84131

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	1473276	1134152986,1598290157,1275198780,1679977060

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
PED363305-01	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Westside Primary Care Center	1657 Georgesville Square Drive	COLUMBUS	OH	Active
PED363305-02	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Near East Primary Care Center	1125 EAST MAIN STREET	COLUMBUS	OH	Active
PED363305-03	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Northland Primary Care Center	4560 MORSE CENTRE ROAD	COLUMBUS	OH	Active
PED363305-04	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER/Whitehall Primary Care Center	561 SOUTH YEARLING ROAD	COLUMBUS	OH	Active
PED363305-05	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER/Adolescent Medicine Clinic East Broad	6435 EAST BROAD STREET	COLUMBUS	OH	Active
PED363305-06	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER/Adolescent Medicine Clinic Dublin	5675 VENTURE DRIVE	DUBLIN	OH	Active
PED363305-07	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME-DOWNTOWN/Adolescent Medicine Clinic	380 Butterfly Gardens Drive	COLUMBUS	OH	Active
PED363305-08	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Eastland Primary Care Center	2599 SOUTH HAMILTON RD	COLUMBUS	OH	Active
PED363305-09	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Hilltop Primary Care Center	2857 WEST BROAD STREET	COLUMBUS	OH	Active
PED363305-10	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Linden Primary Care Center	1390 CLEVELAND AVENUE	COLUMBUS	OH	Active
PED363305-11	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME PHYSICIAN CARE CENTER / Olentangy Primary Care Center	5070 N High St	COLUMBUS	OH	Active
PED363305-12	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	SOUTH HIGH CENTER FOR PRIMARY CARE / South High Primary Care Center	1405S HIGH ST	COLUMBUS	OH	Active
PED363305-13	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER / Westerville Primary Care Center	433 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Active
PED363305-14	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	DOWNTOWN - CLOSE TO HOME / Teen And Pregnant Clinic	380 Butterfly Gardens Drive	COLUMBUS	OH	Active
PED363305-15	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	SHARON WOODS - PRIMARY CARE CENTER	1777E DUBLIN GRANVILLE RD	COLUMBUS	OH	Active
PED363305-16	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	DOWNTOWN PRIMARY CARE CENTER	380 Butterfly Gardens Drive, Suite 3E/F	Columbus	OH	Active
PED363305-17	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	PRIMARY CARE CLINIC RED	380 Butterfly Gardens Drive, Suite 3E/F	Columbus	OH	Terminated
PED363305-18	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	IMMUNODEFICIENCY CLINIC	380 Butterfly Gardens Dr., Suite 2B	Columbus	OH	Active
PED363305-19	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Rheumatology Clinic Dublin	5675 VENTURE DR	DUBLIN	OH	Active
PED363305-20	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic Westerville	433 N CLEVELAND AVE	WESTERVILLE	OH	Active
PED363305-21	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-22	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic East Broad	6435 E BROAD ST	COLUMBUS	OH	Active
PED363305-23	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	WESTERVILLE SURGERY CENTER - Neurology Clinic Westerville	455 EXECUTIVE CAMPUS DR	WESTERVILLE	OH	Active
PED363305-24	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Dermatology Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-25	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - PULMONARY CLINIC WESTERVILLE	433 N CLEVELAND AVE	WESTERVILLE	OH	Active
PED363305-26	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - Neurology Clinic Dublin	5675 VENTURE DR	DUBLIN	OH	Active
PED363305-27	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	BH Psychiatry BHP	444 BUTTERFLY GARDENS DR	COLUMBUS	OH	Active
PED363305-28	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	ENDOCRINOLOGY - ENDOCRINOLOGY CLINIC LAC	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-29	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	GI Clinic Westerville - GI Clinic Westerville	455 Executive Campus Drive	Westerville	OH	Active
PED363305-30	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME HEALTH CARE CENTER - GI Clinic Dublin	5665 VENTURE DR	DUBLIN	OH	Active
PED363305-31	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	LEWIS CENTER CLOSE TO HOME CENTER - HEMATOLOGY/ONCOLOGY INFUSION LEWIS CENTER	7853 PACER DR	DELAWARE	OH	Active
PED363305-32	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	WESTERVILLE SURGERY CENTER - DERMATOLOGY CLINIC WESTERVILLE	455 EXECUTIVE CAMPUS DR	WESTERVILLE	OH	Active
PED363305-33	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Lincoln Village Primary Care Center - Lincoln Village Primary Care Center	4766 W. Broad St	Columbus	OH	Active
PED363305-34	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	CLOSE TO HOME-DOWNTOWN/Adolescent Medicine Clinic - BC4Teens	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-35	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Pulmonology Clinic - PULMONARY CLINIC DUBLIN	5665 Venture Drive	Dublin	OH	Active
PED363305-36	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY WESTERVILLE	455 Executive Campus Dr	Westerville	OH	Active
PED363305-37	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY EAST BROAD	6435 East Broad Street	Columbus	OH	Active
PED363305-38	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY CANAL WINCHESTER	7901 Diley Rd.	Canal Winchester	OH	Active
PED363305-39	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Ped & Adol Gynecology Clinic - PEDIATRIC AND ADOLESCENT GYNECOLOGY DUBLIN	5675 Venture Drive	Dublin	OH	Active
PED363305-40	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Allergy Clinic - ALLERGY CLINIC HILLIARD	4363 All Seasons Dr	Hilliard	OH	Active
PED363305-41	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Allergy Clinic - ALLERGY CLINIC LEWIS CENTER	7853 Pacer Drive	Delaware	OH	Active
PED363305-42	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Developmental Behavioral Peds - DEVELOPMENTAL BEHAVIORAL PEDIATRICS CLINIC	380 Butterfly Gardens Dr	Columbus	OH	Active
PED363305-44	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Developmental Behavioral Peds - DEVELOPMENTAL BEHAVIORAL PEDIATRICS CLINIC WESTERVILLE	187 West Schrock Road	Westerville	OH	Active
PED363305-45	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Outpatient Psychiatry - BH PSYCHIATRY 275 SCHROCK RD	275 W. SCHROCK RD.	Westerville	OH	Active
PED363305-46	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Endocrinology Clinic - ENDOCRINOLOGY CLINIC CANAL WINCHESTER	7901 Diley Road Suite 150	Canal Winchester	OH	Active
PED363305-47	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Emergency Dept - Lewis Center - EMERGENCY DEPARTMENT LEWIS CENTER	7853 Pacer Drive	Delaware	OH	Active
PED363305-48	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Child Assessment Center - CHILD ASSESSMENT CENTER	655 E Livingston Avenue	Columbus	OH	Active
PED363305-49	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Dermatology Clinic - DERMATOLOGY CLINIC CANAL WINCHESTER	7901 Diley Road	Canal Winchester	OH	Active
PED363305-50	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Neurology Clinic - NEUROLOGY CLINIC EAST BROAD	6435 East Broad	Columbus	OH	Active
PED363305-51	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	Northern Lights - Northern Lights Primary Care Center	Northern Lights Shopping Center, 3553 Cleveland Avenue	Columbus	OH	Active
PED363305-52	Child	PED	NATIONWIDE CHILDREN'S HOSPITAL	RHEUMATOLOGY CLINIC - RHEUMATOLOGY CLINIC LOSC	405 Butterfly Gardens Drive	Columbus	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Group Change Request	Nationwide Children's Hospital Pharmacy 700 Children's Drive Columbus, OH 43205	Nationwide Children's Hospital PO Box 31772 Salt Lake City, UT 84131	1/3/2025 11:20 AM
Contacts	Primary Contact	Update	Group Change Request	Skelton, Jasmine 340B Coordinator Nationwide Children's Hospital 6147225799	Labuhn, Jonathan Director, Pharmacy Finance & Supply Chain Nationwide Children's Hospital 6147220412	10/1/2024 10:02 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 9:07:23 AM	8/19/2024 11:33:59 AM	8/19/2024 11:33 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1679977060	1/10/2024 2:50 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	1/10/2024 2:50 PM
Contacts	Authorizing Official	Update	Profile Change Request	Brown, Luke Vice President of Finance & Controller Nationwide Childrens Hospital 6143553117	Brown, Luke Vice President of Finance and Treasury Nationwide Childrens Hospital 6143553117	11/22/2023 6:30 AM
Contacts	Primary Contact	Update	Profile Change Request	Skelton, Jasmine 340b Coordinator Nationwide Children's Hospital 6147225799	Skelton, Jasmine 340B Coordinator Nationwide Children's Hospital 6147225799	11/15/2023 7:57 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:44:58 PM	8/25/2023 9:07:23 AM	8/25/2023 9:07 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 12:52:10 PM	9/6/2022 12:44:58 PM	9/6/2022 12:44 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1417955170 (OH)		7/8/2022 2:46 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1235303926 (OH)		7/8/2022 2:46 PM
Contacts	Primary Contact	Update	Group Change Request	Parsons, Crista Pharmacy Business Manager Nationwide Children's Hospital 6147226972	Skelton, Jasmine 340b Coordinator Nationwide Children's Hospital 6147225799	10/8/2021 8:53 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 12:10:10 PM	9/3/2021 12:52:10 PM	9/3/2021 12:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1417955170	9/4/2020 12:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/4/2020 12:10 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275198780	9/4/2020 12:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/4/2020 12:10 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235303926	9/4/2020 12:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/4/2020 12:10 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	9/4/2020 12:10 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	9/4/2020 12:10 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 11:29:42 AM	9/4/2020 12:10:10 PM	9/4/2020 12:10 PM
Contacts	Primary Contact	Update	Change Request	Huffman, Doug Pharmacy Purchasing Coordinator Nationwide Children's Hospital 6147222179	Parsons, Crista Pharmacy Business Manager Nationwide Children's Hospital 6147226972	3/3/2020 1:54 PM
Details	Last Recertification Date	Update	Recertification	8/30/2018 12:24:39 PM	9/4/2019 11:29:42 AM	9/4/2019 11:29 AM
Details	Last Recertification Date	Update	Recertification	11/17/2017 10:38:01 AM	8/30/2018 12:24:39 PM	8/30/2018 12:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598290157	11/17/2017 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	11/17/2017 10:38:01 AM	11/17/2017 10:38 AM
Details	Entity Name	Update	Recertification	NATIONWIDE CHILDRENS HOSPITAL	NATIONWIDE CHILDREN'S HOSPITAL	11/17/2017 10:24 AM
Contacts	Authorizing Official	Update		Brown, Luke Vice President of Finance & Controller 6143553117	Brown, Luke Vice President of Finance & Controller Nationwide Childrens Hospital 6143553117	10/20/2017 11:55 AM
Contacts	Primary Contact	Update		Huffman, Doug Pharmacy Purchasing Coordinator 6147222179	Huffman, Doug Pharmacy Purchasing Coordinator Nationwide Children's Hospital 6147222179	10/20/2017 5:34 AM
Contacts	Signed By	Insert			KAPPELER, KARL Vice President - Operations and Professional Services 6147225121	6/12/2017 11:22 AM
Contacts	Authorizing Official	Insert			Brown, Luke Vice President of Finance & Controller 6143553117	6/12/2017 11:22 AM
Contacts	Primary Contact	Insert			Huffman, Doug Pharmacy Purchasing Coordinator 6147222179	6/12/2017 11:22 AM
Addresses	Main Address	Insert			1777E DUBLIN GRANVILLE RD COLUMBUS, OH 43229-3502	1/10/2017 4:22 PM
Addresses	Billing Address	Insert			Nationwide Children's Hospital Pharmacy 700 Children's Drive Columbus, OH 43205	1/10/2017 4:22 PM
Medicaid Billing	NPI: Number	Insert			1134152986	8/24/2016 11:23 AM
Details	Last Recertification Date	Update			8/24/2016 12:00:00 AM	8/24/2016 11:23 AM
Dates	Participating Approval Date	Update			11/24/2015 12:00:00 AM	11/24/2015 10:45 AM
Details	State	Update		Pending	Active	11/24/2015 10:45 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/24/2015 10:45 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54520	PED363305-15	11/24/2015 7:59 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54520	10/6/2015 10:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/6/2015 10:30 AM
Medicaid Billing	Medicaid: Number	Insert			1473276	10/6/2015 10:30 AM
Medicaid Billing	Medicaid: State	Insert			OH	10/6/2015 10:30 AM
Details	Last Recertification Date	Insert				10/6/2015 10:30 AM
Details	Grant Number	Insert				10/6/2015 10:30 AM
Details	340B ID	Insert				10/6/2015 10:30 AM
Details	Is Authorizing Official EHB Data	Insert				10/6/2015 10:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/6/2015 10:30 AM
Details	Medicare Provider Number	Insert			363305	10/6/2015 10:30 AM
Details	Entity Name	Insert			NATIONWIDE CHILDRENS HOSPITAL	10/6/2015 10:30 AM
Details	Program Code	Insert			PED	10/6/2015 10:30 AM
Details	Entity Subname	Insert			SHARON WOODS - PRIMARY CARE CENTER	10/6/2015 10:30 AM
Dates	Participating Approval Date	Insert				10/6/2015 10:30 AM
Details	State	Insert			Pending	10/6/2015 10:30 AM
Dates	Registration Date	Insert			10/6/2015 12:00:00 AM	10/6/2015 10:30 AM
Dates	Signed By Date	Insert			10/6/2015 12:00:00 AM	10/6/2015 10:30 AM
Dates	Start Date	Insert				10/6/2015 10:30 AM
Terminations	Termination Comments	Insert				10/6/2015 10:30 AM
Terminations	Termination Date	Insert				10/6/2015 10:30 AM
Terminations	Termination Effective Date	Insert				10/6/2015 10:30 AM
Terminations	Termination Reason	Insert				10/6/2015 10:30 AM