Covered Entity Details

DSH360118B MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL (Active) - information as of 4/27/2025 12:55:34 AM

Main Details

Name

MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL

Subdivision Name

Ontario Freestanding Emergency Department - Emergency Department

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH360118B

Medicare Provider Number

360118

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2019

Participating Start Date

4/1/2019

Participating Approval Date

2/19/2019

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

OhioHealth
Curtis L Gingrich, President
(419) 526-8403

Primary Contact

OhioHealh
Eva Brahimaj, Site Manager
(419) 526-8084

Addresses

Street Address

1365 North Lexington-Springmill Road
Ontario, OH 44906

Billing Address

OhioHealth
PO Box 9
Columbus, OH 43216

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	5489663,0418885	1790837235,1629696802

Shipping Addresses

Shipping Address 1

OhioHealth Mansfield Hospital
335 Glessner Ave
Mansfield, OH 44903

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
DSH360118A	Child	DSH	MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL	Cricket Lane Surgery Center	1030 Cricket Lane	Mansfield	OH	Active
DSH360118B	Child	DSH	MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL	Ontario Freestanding Emergency Department - Emergency Department	1365 North Lexington-Springmill Road	Ontario	OH	Active
DSH360118C	Child	DSH	MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL	ASHLAND CARDIOVASCULAR IMAGING - CARDIOLOGY	45 Amberwood Parkway	Ashland	OH	Active
DSH360118D	Child	DSH	MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL	OHIOHEALTH EMERG CARE- ASHLAND - OhioHealth Ashland Freestanding Emergency Department	1720 OHIOHEALTH WAY	ASHLAND	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Lyren, Joseph S VP Finance OhioHealth 4195268417	Gingrich, Curtis L President OhioHealth 4195268403	12/17/2024 8:00 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 10:00:45 AM	8/30/2024 9:58:07 AM	8/30/2024 9:58 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 2:20:00 PM	9/6/2023 10:00:45 AM	9/6/2023 10:00 AM
Contacts	Authorizing Official	Update	Profile Change Request	Lyren, Joseph S VP Finance North Market OhioHealth 4195268417	Lyren, Joseph S VP Finance OhioHealth 4195268417	8/30/2022 6:06 AM
Contacts	Signed By	Update	Profile Change Request	Lyren, Joseph S VP Finance North Market OhioHealth 4195268417	Lyren, Joseph S VP Finance OhioHealth 4195268417	8/30/2022 6:06 AM
Addresses	Billing Address	Update	Recertification	OhioHealth Mansfield Hospital 335 Glessner Ave Mansfield, OH 44903	OhioHealth PO Box 9 Columbus, OH 43216	8/29/2022 2:20 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 4:44:08 PM	8/29/2022 2:20:00 PM	8/29/2022 2:20 PM
Addresses	Billing Address	Insert	Recertification		OhioHealth Mansfield Hospital 335 Glessner Ave Mansfield, OH 44903	8/16/2021 4:44 PM
Addresses	Shipping Address	Insert	Recertification		OhioHealth Mansfield Hospital 335 Glessner Ave Mansfield, OH 44903	8/16/2021 4:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/16/2021 4:44 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0418885	8/16/2021 4:44 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	8/16/2021 4:44 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1629696802	8/16/2021 4:44 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/16/2021 4:44 PM
Details	Last Recertification Date	Update	Recertification	9/7/2020 10:04:46 AM	8/16/2021 4:44:08 PM	8/16/2021 4:44 PM
Details	Entity Name	Update	Recertification	MEDCENTRAL HEALTH SYSTEM	MEDCENTRAL HEALTH SYSTEM DBA OHIOHEALTH MANSFIELD HOSPITAL	9/9/2020 7:44 AM
Medicaid Billing	NPI: State	Update	Recertification		OH	9/7/2020 10:04 AM
Contacts	Primary Contact	Update	Recertification	George, Brian Pharmacy Site Manager OhioHealth 4195268843	Brahimaj, Eva Site Manager OhioHealh 4195268084	9/7/2020 10:04 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 12:01:01 PM	9/7/2020 10:04:46 AM	9/7/2020 10:04 AM
Contacts	Authorizing Official	Update	Profile Change Request	Lyren, Joseph S VP Finance OhioHealth Mansfield and Shelby Hospitals 4195268417	Lyren, Joseph S VP Finance North Market OhioHealth 4195268417	8/24/2020 11:12 AM
Contacts	Signed By	Update	Profile Change Request	Lyren, Joseph S VP Finance OhioHealth Mansfield and Shelby Hospitals 4195268417	Lyren, Joseph S VP Finance North Market OhioHealth 4195268417	8/24/2020 11:12 AM
Details	Last Recertification Date	Update	Recertification		8/26/2019 12:01:01 PM	8/26/2019 12:01 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Lyren, Joseph S VP Finance OhioHealth Mansfield and Shelby Hospitals 4195268417	2/19/2019 10:43 AM
Details	340B ID	Update	New Registration		DSH360118B	2/19/2019 10:43 AM
Details	Entity Subname	Update	New Registration	Ontario Freestanding Emergency Department	Ontario Freestanding Emergency Department - Emergency Department	2/19/2019 10:43 AM
Dates	Participating Approval Date	Update	New Registration		2/19/2019 10:43:47 AM	2/19/2019 10:43 AM
Details	State	Update	New Registration	Pending	Approved	2/19/2019 10:43 AM
Dates	Signed By Date	Update	New Registration		2/14/2019 2:38:52 PM	2/19/2019 10:43 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	2/19/2019 10:43 AM
Addresses	Main Address	Insert	New Registration		1365 North Lexington-Springmill Road Ontario, OH 44906	1/11/2019 1:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2019 1:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		5489663	1/11/2019 1:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/11/2019 1:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1790837235	1/11/2019 1:43 PM
Contacts	Primary Contact	Insert	New Registration		George, Brian Pharmacy Site Manager OhioHealth 4195268843	1/11/2019 1:43 PM
Contacts	Authorizing Official	Insert	New Registration		Lyren, Joseph S VP Finance OhioHealth Mansfield and Shelby Hospitals 4195268417	1/11/2019 1:43 PM
Details	Last Recertification Date	Insert	New Registration			1/11/2019 1:43 PM
Details	Grant Number	Insert	New Registration			1/11/2019 1:43 PM
Details	340B ID	Insert	New Registration			1/11/2019 1:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2019 1:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2019 1:43 PM
Details	Medicare Provider Number	Insert	New Registration		360118	1/11/2019 1:43 PM
Details	Entity Name	Insert	New Registration		MEDCENTRAL HEALTH SYSTEM	1/11/2019 1:43 PM
Details	Program Code	Insert	New Registration		DSH	1/11/2019 1:43 PM
Details	Entity Subname	Insert	New Registration		Ontario Freestanding Emergency Department	1/11/2019 1:43 PM
Dates	Participating Approval Date	Insert	New Registration			1/11/2019 1:43 PM
Details	State	Insert	New Registration		Pending	1/11/2019 1:43 PM
Dates	Registration Date	Insert	New Registration		1/11/2019 1:43:35 PM	1/11/2019 1:43 PM
Dates	Signed By Date	Insert	New Registration			1/11/2019 1:43 PM
Dates	Start Date	Insert	New Registration			1/11/2019 1:43 PM
Terminations	Termination Comments	Insert	New Registration			1/11/2019 1:43 PM
Terminations	Termination Date	Insert	New Registration			1/11/2019 1:43 PM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2019 1:43 PM
Terminations	Termination Reason	Insert	New Registration			1/11/2019 1:43 PM