Covered Entity Details

DSH360012K ST. ANN'S HOSP OF COLUMBUS INC, (Active) - information as of 5/30/2025 8:15:36 PM

Main Details

Name

ST. ANN'S HOSP OF COLUMBUS INC,

Subdivision Name

CLINICAL CARDIOVASCULAR SPECIALISTS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360012K

Medicare Provider Number

360012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/26/2015

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Mount Carmel Health System
Andrew Rawn Priday, Chief Financial Officer
(614) 546-4146

Primary Contact

Mount Carmel Health System
Terrance John Slavin, Regional Director of Reimbursement
(734) 343-3320

Addresses

Street Address

477 COOPER ROAD
SUITE 200
WESTERVILLE, OH 43081-8054

Billing Address

MOUNT CARMEL HEALTH SYSTEM
3100 Easton Square Place
Suite 300 - Finance
Columbus, OH 43219-6290

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	7643394	1417037045

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
DSH360012A	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Mount Carmel St. Ann's Medical Outpatient Care	495 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012AA	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Heart & Vascular Imaging Center	7100 Graphics Way	Lewis Center	OH	Terminated
DSH360012AB	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Cardiac Rehab	7100 Graphics Way	Lewis Center	OH	Terminated
DSH360012AC	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	LEWIS CENTER REHAB SERVICES	7100 Graphics Way	Lewis Center	OH	Active
DSH360012AD	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	LEWIS CENTER ANTICOAGULATION	7100 Graphics Way	Lewis Center	OH	Terminated
DSH360012AE	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MOUNT CARMEL ST. ANN'S RADIATION THERAPY - RADIATION THERAPY	495 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012AF	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MOUNT CARMEL ST. ANN'S PAIN MANAGEMENT - PAIN MANAGEMENT	495 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012AG	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Wound Care Clinic - Wound Care	477 Cooper Road	Westerville	OH	Active
DSH360012AH	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Women's Health Center - Women's Health	477 Cooper Road	Westerville	OH	Active
DSH360012B	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	DIAGNOSTIC RADIOLOGY	495 COOPER RD	WESTERVILLE	OH	Terminated
DSH360012C	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	WESTAR IMAGING CENTER	444 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Terminated
DSH360012D	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	COLUMBUS CYBERKNIFE	495 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012E	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MOUNT CARMEL CARDIAC REHABILITATION	444 N CLEVELAND AVE	WESTERVILLE	OH	Active
DSH360012F	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MOUNT CARMEL ST. ANN'S CANCER SERVI	495 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012G	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	WESTAR REHAB & SPORTS MEDICINE / OP OCCUPATIONAL THERAPY	444 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Active
DSH360012H	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	WESTAR REHAB & SPORTS MEDICINE / OP PHYSICAL THERAPY	444 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Terminated
DSH360012J	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	WESTAR REHAB & SPORTS MEDICINE / OP SPEECH THERAPY	444 NORTH CLEVELAND AVENUE	WESTERVILLE	OH	Terminated
DSH360012K	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	CLINICAL CARDIOVASCULAR SPECIALISTS	477 COOPER ROAD	WESTERVILLE	OH	Active
DSH360012L	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MCSA GI CENTER	495 COOPER RD 411	WESTERVILLE	OH	Terminated
DSH360012M	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	MOUNT CARMEL ST. ANN'S-OB CLINIC	495 COOPER ROAD	WESTERVILLE	OH	Terminated
DSH360012N	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	WEDGEWOOD WOMEN'S HEALTH	10330 SAWMILL PARKWAY	POWELL	OH	Terminated
DSH360012P	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Women's Health Center	7100 Graphics Way	Lewis Center	OH	Active
DSH360012Q	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Diabetes Self Mgmt Ed	7100 Graphics Way	Lewis Center	OH	Terminated
DSH360012R	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Heart Failure Services	7100 Graphics Way	Lewis Center	OH	Terminated
DSH360012S	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	GI Center	495 Cooper Road	Westerville	OH	Terminated
DSH360012T	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Emergency Department	7100 Graphics Way	Lewis Center	OH	Active
DSH360012U	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Clinical Lab	7100 Graphics Way	Lewis Center	OH	Active
DSH360012V	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	PET Positron Emission Tomography	495 Cooper Road	Westerville	OH	Active
DSH360012W	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center MRI	7100 Graphics Way	Lewis Center	OH	Active
DSH360012X	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Ultrasound	7100 Graphics Way	Lewis Center	OH	Active
DSH360012Y	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center CT	7100 Graphics Way	Lewis Center	OH	Active
DSH360012Z	Child	DSH	ST. ANN'S HOSP OF COLUMBUS INC,	Lewis Center Diagnostic Radiology	7100 Graphics Way	Lewis Center	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Kreatsoulas, Nicholas Executive Vice President & Chief Clinical Operations Officer Mount Carmel Health System 6145463266	Priday, Andrew Rawn Chief Financial Officer Mount Carmel Health System 6145464146	4/16/2025 1:59 PM
Details	Last Recertification Date	Update	Recertification	8/23/2023 1:40:08 PM	8/16/2024 8:07:40 AM	8/16/2024 8:07 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 12:59:09 PM	8/23/2023 1:40:08 PM	8/23/2023 1:40 PM
Addresses	Shipping Address	Delete	Change Request	MOUNT CARMEL HEALTH SYSTEM 3100 Easton Square Place Suite 300 - Finance Columbus, OH 43219-6290		9/21/2022 3:03 PM
Addresses	Shipping Address	Insert	Recertification		MOUNT CARMEL HEALTH SYSTEM 3100 Easton Square Place Suite 300 - Finance Columbus, OH 43219-6290	9/12/2022 12:59 PM
Addresses	Billing Address	Update	Recertification	MOUNT CARMEL HEALTH SYSTEM 6150 E BROAD ST 3RD FLOOR FINANCE - CFO COLUMBUS, OH 43213	MOUNT CARMEL HEALTH SYSTEM 3100 Easton Square Place Suite 300 - Finance Columbus, OH 43219-6290	9/12/2022 12:59 PM
Addresses	Shipping Address	Delete	Recertification	MOUNT CARMEL ST. ANN'S 500 S CLEVELAND AVE WESTERVILLE, OH 43081		9/12/2022 12:59 PM
Details	Last Recertification Date	Update	Recertification	8/25/2021 1:14:36 PM	9/12/2022 12:59:09 PM	9/12/2022 12:59 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 1:52:01 PM	8/25/2021 1:14:36 PM	8/25/2021 1:14 PM
Contacts	Primary Contact	Update	Group Change Request	Ware, Steve Reimbursement Manager St. Ann's Hospital 6145463290	Slavin, Terrance John Regional Director of Reimbursement Mount Carmel Health System 7343433320	7/27/2021 7:08 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1417037045	8/18/2020 1:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/18/2020 1:52 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1417037045 ( )		8/18/2020 1:52 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:50:46 PM	8/18/2020 1:52:01 PM	8/18/2020 1:52 PM
Contacts	Authorizing Official	Update	Change Request	Morris, Paul CFO & Executive V.P. St. Ann's Hospital 6145464620	Kreatsoulas, Nicholas Executive Vice President & Chief Clinical Operations Officer Mount Carmel Health System 6145463266	1/7/2020 3:38 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 7:52:24 AM	8/20/2019 7:50:46 PM	8/20/2019 7:50 PM
Details	Last Recertification Date	Update	Recertification	11/7/2017 10:29:43 AM	8/22/2018 7:52:24 AM	8/22/2018 7:52 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1417037045	7/2/2018 9:26 AM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/7/2017 10:29:43 AM	11/7/2017 10:29 AM
Contacts	Authorizing Official	Insert	Change Request		Morris, Paul CFO & Executive V.P. St. Ann's Hospital 6145464620	9/28/2017 8:27 AM
Details	Entity Name	Update	Change Request	ST. ANNS HOSPITAL	ST. ANN'S HOSP OF COLUMBUS INC,	9/28/2017 8:27 AM
Contacts	Primary Contact	Update	Profile Change Request	Ware, Steve Reimbursement Manager Mount Carmel Health 6145463290	Ware, Steve Reimbursement Manager St. Ann's Hospital 6145463290	9/27/2017 9:26 AM
Contacts	Primary Contact	Update	Profile Change Request	Ware, Steve Reimbursement Manager st.ann's hospital 6145463290	Ware, Steve Reimbursement Manager Mount Carmel Health 6145463290	9/27/2017 9:22 AM
Contacts	Primary Contact	Update		Ware, Steve Reimbursement Manager 6145463290	Ware, Steve Reimbursement Manager st.ann's hospital 6145463290	9/25/2017 9:29 AM
Contacts	Primary Contact	Insert			Ware, Steve Reimbursement Manager 6145463290	7/13/2017 10:48 AM
Addresses	Main Address	Insert			477 COOPER ROAD SUITE 200 WESTERVILLE, OH 43081-8054	2/24/2017 2:05 PM
Addresses	Billing Address	Insert			MOUNT CARMEL HEALTH SYSTEM 6150 E BROAD ST 3RD FLOOR FINANCE - CFO COLUMBUS, OH 43213	2/24/2017 2:05 PM
Addresses	Shipping Address	Insert			MOUNT CARMEL ST. ANN'S 500 S CLEVELAND AVE WESTERVILLE, OH 43081	2/24/2017 2:05 PM
Contacts	Signed By	Insert			COLEMAN, KEITH T. SENIOR V.P. OF FINANCE & CFO 6145464300	2/24/2017 2:05 PM
Details	Last Recertification Date	Update			8/31/2016 12:00:00 AM	8/31/2016 2:53 PM
Dates	Participating Approval Date	Update			10/26/2015 12:00:00 AM	10/26/2015 1:54 PM
Details	State	Update		Pending	Active	10/26/2015 1:54 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/26/2015 1:54 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54896	DSH360012K	10/13/2015 2:51 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54896	10/9/2015 1:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/9/2015 1:13 PM
Medicaid Billing	Medicaid: Number	Insert			7643394	10/9/2015 1:13 PM
Medicaid Billing	Medicaid: State	Insert			OH	10/9/2015 1:13 PM
Details	Last Recertification Date	Insert				10/9/2015 1:13 PM
Details	Grant Number	Insert				10/9/2015 1:13 PM
Details	340B ID	Insert				10/9/2015 1:13 PM
Details	Is Authorizing Official EHB Data	Insert				10/9/2015 1:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/9/2015 1:13 PM
Details	Medicare Provider Number	Insert			360012	10/9/2015 1:13 PM
Details	Entity Name	Insert			ST. ANNS HOSPITAL	10/9/2015 1:13 PM
Details	Program Code	Insert			DSH	10/9/2015 1:13 PM
Details	Entity Subname	Insert			CLINICAL CARDIOVASCULAR SPECIALISTS	10/9/2015 1:13 PM
Dates	Participating Approval Date	Insert				10/9/2015 1:13 PM
Details	State	Insert			Pending	10/9/2015 1:13 PM
Dates	Registration Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 1:13 PM
Dates	Signed By Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 1:13 PM
Dates	Start Date	Insert				10/9/2015 1:13 PM
Terminations	Termination Comments	Insert				10/9/2015 1:13 PM
Terminations	Termination Date	Insert				10/9/2015 1:13 PM
Terminations	Termination Effective Date	Insert				10/9/2015 1:13 PM
Terminations	Termination Reason	Insert				10/9/2015 1:13 PM