Covered Entity Details

DSH360134S THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO (Active) - information as of 5/1/2025 11:49:20 PM

Main Details

Name

THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

Subdivision Name

GOOD SAMARITAN INFUSION CTR OXFORD - Infusion

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360134S

Medicare Provider Number

360134

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/5/2021

Participating Start Date

4/1/2021

Participating Approval Date

2/18/2021

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

The Good Samaritan Hospital of Cincinnati Ohio
Michael Crofton, Sr. Vice President & CFO
(513) 569-6577

Primary Contact

The Good Samaritan Hospital of Cincinnati Ohio
Greg Nocito, Director of Pharmacy Operations
(513) 865-1495

Addresses

Street Address

110 N POPLAR ST
STE 101
OXFORD, OH 45056-1204

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		1508835828
IN		1508835828
KY		1508835828

Shipping Addresses

Shipping Address 1

McCullough-Hyde Memorial Hospital
110 N POPLAR ST
Oxford, OH 45056-1204

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
DSH360134A	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	CLINIC	375 DIXMYTH AVE	CINCINNATI	OH	Active
DSH360134AA	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Medical Specialties - Anderson - Rheumatology	7794 Five Mile Rd	Cincinnati	OH	Active
DSH360134AB	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN SURGERY CENTER WEST - Outpatient Surgery Center	3660 EDGEWOOD DR	CINCINNATI	OH	Active
DSH360134AC	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Medical Specialties - Anderson - Endocrinology - Endocrinology	7794 Five Mile Rd	Cincinnati	OH	Active
DSH360134AD	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Rheumatology -BC - Rheumatology	3035 Hamilton Mason Rd	Hamilton	OH	Active
DSH360134AE	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Rheumatology - Evendale - Rheumatology	3147 Glendale Milford Rd	Cincinnati	OH	Active
DSH360134AF	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN ENDOCRINOLOGY MONTGO - ENDOCRINOLOGY	10506 MONTGOMERY RD	MONTGOMERY	OH	Active
DSH360134AG	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Endocrinology - Western Ridge - Endocrinology	6949 Good Samaritan Dr	Cincinnati	OH	Active
DSH360134AH	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN WEIGHT MGMT MONTGOME - Weight Management	10496 MONTGOMERY RD	MONTGOMERY	OH	Active
DSH360134AJ	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Weight Management Butler - Weight Management	3035 Hamilton Mason Road	Hamilton	OH	Active
DSH360134AK	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Weight Management Western Ridge - Weight Management	6949 Good Samaritan Drive Suite	Cincinnati	OH	Active
DSH360134B	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Infusion Center Western Ridge	6949 Good Samaritan Drive	Cincinnati	OH	Active
DSH360134C	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infusion Center - Kenwood	8240 Northcreek Drive	Cincinnati	OH	Active
DSH360134D	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infusion Center - Anderson	7777 Beechmont Ave	Cincinnati	OH	Active
DSH360134E	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Medical Center at Western Ridge	6949 Good Samaritan Drive	Cincinnati	OH	Terminated
DSH360134F	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infusion Center GH MOB	379 Dixmyth Ave	Cincinnati	OH	Terminated
DSH360134G	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN INFUSION CENTER BUTLER	3035 HAMILTON MASON RD	HAMILTON	OH	Active
DSH360134H	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN CARDIAC TESTING-CLIF	3219 CLIFTON AVE	CINCINNATI	OH	Active
DSH360134J	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN CARDIAC AND VASCULAR / Good Samaritan Cardiac and Vascular Testing - Anderson	7777 BEECHMONT AVE	CINCINNATI	OH	Active
DSH360134K	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Western Ridge Diagnostic Center	6949 Good Samaritan Drive	Cincinnati	OH	Active
DSH360134L	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Western Ridge Emergency Department	6949 Good Samaritan Drive	Cincinnati	OH	Active
DSH360134M	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Western Ridge Cardiology	6949 Good Samaritan Drive	Cincinnati	OH	Active
DSH360134N	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Western Ridge Vascular Testing	6949 Good Samaritan Dr	Cincinnati	OH	Active
DSH360134P	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infusion Center - Western Ridge	6949 Good Samaritan Dr.	Cincinnati	OH	Terminated
DSH360134Q	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Infusion Center Thomas Center	10506 Montgomery Rd	Cincinnati	OH	Active
DSH360134R	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Infusion - Arrow Springs - Good Samaritan Infusion - Arrow Springs	100 Arrow Springs Blvd.	Lebanon	OH	Active
DSH360134S	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN INFUSION CTR OXFORD - Infusion	110 N POPLAR ST	OXFORD	OH	Active
DSH360134T	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infectious Disease-BC - Infectious Disease	3035 Hamilton Mason Rd	Hamilton	OH	Active
DSH360134U	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infectious Disease Montgomery	10506B Montgomery Rd	Montgomery	OH	Active
DSH360134V	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Infectious Disease-WR - Infectious Disease	6949 Good Samaritan Dr	Cincinnati	OH	Active
DSH360134W	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Neurology-WR - Neurology	6949 Good Samaritan Dr	Cincinnati	OH	Active
DSH360134X	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Rheumatology-TC - Rheumatology	10506 Montgomery Rd	Cincinnati	OH	Active
DSH360134Y	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	Good Samaritan Hospital Rheumatology-WR - Rheumatology	6949 Good Samaritan Dr	Cincinnati	OH	Active
DSH360134Z	Child	DSH	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	GOOD SAMARITAN INFECTIOUS DISEASE C - Good Samaritan Hospital Infectious Disease-MOB	3219 CLIFTON AVE	CINCINNATI	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Nocito, Greg Sr. Pharmacy Manager The Good Samaritan Hospital of Cincinnati Ohio 5138621933	Nocito, Greg Director of Pharmacy Operations The Good Samaritan Hospital of Cincinnati Ohio 5138651495	9/17/2024 1:09 PM
Details	Last Recertification Date	Update	Recertification	8/31/2023 1:19:54 PM	8/20/2024 10:16:04 AM	8/20/2024 10:16 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 1:18:44 PM	8/31/2023 1:19:54 PM	8/31/2023 1:19 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 3:13:40 PM	8/29/2022 1:18:44 PM	8/29/2022 1:18 PM
Details	Last Recertification Date	Update	Recertification		8/26/2021 3:13:40 PM	8/26/2021 3:13 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Crofton, Michael Sr. Vice President & CFO The Good Samaritan Hospital of Cincinnati Ohio 5135696577	2/18/2021 8:05 AM
Details	340B ID	Update	New Registration		DSH360134S	2/18/2021 8:05 AM
Details	Entity Name	Update	New Registration	GOOD SAMARITAN HOSPITAL	THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO	2/18/2021 8:05 AM
Details	Entity Subname	Update	New Registration	GOOD SAMARITAN INFUSION CTR OXFORD	GOOD SAMARITAN INFUSION CTR OXFORD - Infusion	2/18/2021 8:05 AM
Dates	Participating Approval Date	Update	New Registration		2/18/2021 8:05:45 AM	2/18/2021 8:05 AM
Details	State	Update	New Registration	Pending	Approved	2/18/2021 8:05 AM
Dates	Signed By Date	Update	New Registration		1/7/2021 4:11:01 PM	2/18/2021 8:05 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	2/18/2021 8:05 AM
Addresses	Main Address	Insert	New Registration		110 N POPLAR ST STE 101 OXFORD, OH 45056-1204	1/5/2021 11:11 AM
Addresses	Shipping Address	Insert	New Registration		McCullough-Hyde Memorial Hospital 110 N POPLAR ST Oxford, OH 45056-1204	1/5/2021 11:11 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508835828	1/5/2021 11:11 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/5/2021 11:11 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508835828	1/5/2021 11:11 AM
Medicaid Billing	NPI: State	Insert	New Registration		IN	1/5/2021 11:11 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508835828	1/5/2021 11:11 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/5/2021 11:11 AM
Contacts	Authorizing Official	Insert	New Registration		Crofton, Michael Sr. Vice President & CFO The Good Samaritan Hospital of Cincinnati Ohio 5135696577	1/5/2021 11:11 AM
Contacts	Primary Contact	Insert	New Registration		Nocito, Greg Sr. Pharmacy Manager The Good Samaritan Hospital of Cincinnati Ohio 5138621933	1/5/2021 11:11 AM
Details	Assistance Received From Date	Insert	New Registration			1/5/2021 11:11 AM
Details	Assistance Received To Date	Insert	New Registration			1/5/2021 11:11 AM
Details	Last Recertification Date	Insert	New Registration			1/5/2021 11:11 AM
Details	Grant Number	Insert	New Registration			1/5/2021 11:11 AM
Details	340B ID	Insert	New Registration			1/5/2021 11:11 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/5/2021 11:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/5/2021 11:11 AM
Details	Medicare Provider Number	Insert	New Registration		360134	1/5/2021 11:11 AM
Details	Entity Name	Insert	New Registration		GOOD SAMARITAN HOSPITAL	1/5/2021 11:11 AM
Details	NOFO Number	Insert	New Registration			1/5/2021 11:11 AM
Details	Program Code	Insert	New Registration		DSH	1/5/2021 11:11 AM
Details	Entity Subname	Insert	New Registration		GOOD SAMARITAN INFUSION CTR OXFORD	1/5/2021 11:11 AM
Dates	Participating Approval Date	Insert	New Registration			1/5/2021 11:11 AM
Details	State	Insert	New Registration		Pending	1/5/2021 11:11 AM
Dates	Registration Date	Insert	New Registration		1/5/2021 11:11:55 AM	1/5/2021 11:11 AM
Dates	Signed By Date	Insert	New Registration			1/5/2021 11:11 AM
Dates	Start Date	Insert	New Registration			1/5/2021 11:11 AM
Terminations	Termination Comments	Insert	New Registration			1/5/2021 11:11 AM
Terminations	Termination Date	Insert	New Registration			1/5/2021 11:11 AM
Terminations	Termination Effective Date	Insert	New Registration			1/5/2021 11:11 AM
Terminations	Termination Reason	Insert	New Registration			1/5/2021 11:11 AM