Covered Entity Details

DSH360017AN GRANT MEDICAL CENTER (Active) - information as of 4/29/2025 11:47:01 PM

Main Details

Name

GRANT MEDICAL CENTER

Subdivision Name

Bone and Joint Ambulatory - Ambulatory Surgery

Type

Disproportionate Share Hospital

Rural

340B ID

DSH360017AN

Medicare Provider Number

360017

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2021

Participating Start Date

1/1/2022

Participating Approval Date

11/9/2021

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

OhioHealth
Jean Halpin, President
(614) 566-8952

Primary Contact

OhioHealth
Beth Prier, Director Pharmacy Operations
(614) 566-9249

Addresses

Street Address

323 E Town St
Columbus, OH 43215

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	3359253,0419074,0030254	1255377149,1427673185,1699553891

Shipping Addresses

Shipping Address 1

Grant Medical Center
111 South Grant Ave
Columbus, OH 43215

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
DSH360017A	Child	DSH	GRANT MEDICAL CENTER	CLINIC CONGESTIVE HRT FAILURE	GMC William W Wilkins Professional Building	Columbus	OH	Active
DSH360017AA	Child	DSH	GRANT MEDICAL CENTER	Diagnostics Wilkins - Fluoroscopy	303 East Town Street	Columbus	OH	Active
DSH360017AB	Child	DSH	GRANT MEDICAL CENTER	GMC MAT FET MEDICINE - MAT FET MEDICINE	285 E State St Suite 620	Columbus	OH	Active
DSH360017AC	Child	DSH	GRANT MEDICAL CENTER	GCMH DIAGNOSTICS - DIAGNOSTICS	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AD	Child	DSH	GRANT MEDICAL CENTER	GCMH EMERGENCY DEPT - EMERGENCY DEPT	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AE	Child	DSH	GRANT MEDICAL CENTER	GCMH INTRAOP - INTRAOP	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AF	Child	DSH	GRANT MEDICAL CENTER	GCMH PACU - PACU	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AG	Child	DSH	GRANT MEDICAL CENTER	PMH SHORT STAY - SHORT STAY	1010 Refugee Rd	Pickerington	OH	Active
DSH360017AH	Child	DSH	GRANT MEDICAL CENTER	WMC SHORT STAY - SHORT STAY	260 Polaris Parkway 2nd Floor	Westerville	OH	Active
DSH360017AJ	Child	DSH	GRANT MEDICAL CENTER	GCMH PERIOP - PERIOP	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AK	Child	DSH	GRANT MEDICAL CENTER	GCMH MED SURG ORTHO - SURG ORTHO	1375 Stringtown Rd	Grove City	OH	Active
DSH360017AL	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Med Surg Ortho - Med Surg Ortho	323 East Town St.	Columbus	OH	Active
DSH360017AM	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint PACU - PACU	323 E Town St	Columbus	OH	Active
DSH360017AN	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Ambulatory - Ambulatory Surgery	323 E Town St	Columbus	OH	Active
DSH360017AP	Child	DSH	GRANT MEDICAL CENTER	Bone and Joint Anesthesia - Anesthesia	323 E Town St	Columbus	OH	Active
DSH360017AQ	Child	DSH	GRANT MEDICAL CENTER	Radiation Oncology - Radiation Oncology	303 E. Town Street	Columbus	OH	Active
DSH360017AR	Child	DSH	GRANT MEDICAL CENTER	Bone Marrow Transplant Infusion and Apheresis - Infusion	500 Thomas Lane	Columbus	OH	Active
DSH360017AS	Child	DSH	GRANT MEDICAL CENTER	Infusion Center - Bing - Infusion	500 Thomas Lane	Columbus	OH	Active
DSH360017AT	Child	DSH	GRANT MEDICAL CENTER	PMH - Infusion Center	1010 Refugee Road	Pickerington	OH	Active
DSH360017AU	Child	DSH	GRANT MEDICAL CENTER	Cardiac Imaging - Grove City - Cardiac Imaging	1375 Stringtown Road	Grove City	OH	Active
DSH360017AV	Child	DSH	GRANT MEDICAL CENTER	CT Scan - Grove City - CT Scan - Grove City	1375 Stringtown Road	Grove City	OH	Active
DSH360017AW	Child	DSH	GRANT MEDICAL CENTER	PMH - Ultrasound - PMH - Ultrasound	1010 Refugee Road	Pickerington	OH	Active
DSH360017AX	Child	DSH	GRANT MEDICAL CENTER	PMH - Respiratory Therapy - PMH - Respiratory Therapy	1010 Refugee Road	Pickerington	OH	Active
DSH360017AY	Child	DSH	GRANT MEDICAL CENTER	PMH - Pre/Post PACU - PMH - Pre/Post PACU	1010 Refugee Road	Pickerington	OH	Active
DSH360017AZ	Child	DSH	GRANT MEDICAL CENTER	PMH - Neurointerventional Radiology - PMH - Neurointerventional Radiology	1010 Refugee Road	Pickerington	OH	Active
DSH360017B	Child	DSH	GRANT MEDICAL CENTER	BONE & JOINT SURGERY	323 E Town St	Columbus	OH	Active
DSH360017BA	Child	DSH	GRANT MEDICAL CENTER	PMH - MRI - PMH - MRI	1010 Refugee Road	Pickerington	OH	Active
DSH360017BB	Child	DSH	GRANT MEDICAL CENTER	PMH - Labor and Delivery - PMH - Labor and Delivery	1010 Refugee Road	Pickerington	OH	Active
DSH360017BC	Child	DSH	GRANT MEDICAL CENTER	PMH - Surgery Main - PMH - Surgery Main	1010 Refugee Road	Pickerington	OH	Active
DSH360017BD	Child	DSH	GRANT MEDICAL CENTER	PMH - Diagnostics - PMH - Diagnostics	1010 Refugee Road	Pickerington	OH	Active
DSH360017BE	Child	DSH	GRANT MEDICAL CENTER	PMH - CT Scan - PMH - CT Scan	1010 Refugee Road	Pickerington	OH	Active
DSH360017BF	Child	DSH	GRANT MEDICAL CENTER	PMH Cardiac Cath Lab - PMH Cardiac Cath Lab	1010 Refugee Road	Pickerington	OH	Active
DSH360017C	Child	DSH	GRANT MEDICAL CENTER	Adm Day Surgery Outpatient	323 E Town St	Columbus	OH	Active
DSH360017D	Child	DSH	GRANT MEDICAL CENTER	Sleep Lab	285 E State St	Columbus	OH	Terminated
DSH360017E	Child	DSH	GRANT MEDICAL CENTER	Infusion Center	303 E. Town St	Columbus	OH	Active
DSH360017F	Child	DSH	GRANT MEDICAL CENTER	Trauma Clinic	340 E Town St	Columbus	OH	Terminated
DSH360017G	Child	DSH	GRANT MEDICAL CENTER	Arthritis Infusion Center	303 E Town St	Columbus	OH	Active
DSH360017H	Child	DSH	GRANT MEDICAL CENTER	CT Dept Wilkins	285 E Town St	Columbus	OH	Active
DSH360017J	Child	DSH	GRANT MEDICAL CENTER	Mammography Wilkins	285 E State St	Columbus	OH	Active
DSH360017K	Child	DSH	GRANT MEDICAL CENTER	Ultrasound Wilkins	285 E State St	Columbus	OH	Active
DSH360017L	Child	DSH	GRANT MEDICAL CENTER	Wound Care Ctr	285 E State St	Columbus	OH	Active
DSH360017M	Child	DSH	GRANT MEDICAL CENTER	Diagnostics Wilkins	285 E State St	Columbus	OH	Active
DSH360017N	Child	DSH	GRANT MEDICAL CENTER	OHWED EMERGENCY DEPARTMENT	260 Polaris Parkway	Westerville	OH	Active
DSH360017P	Child	DSH	GRANT MEDICAL CENTER	OHWED Pulmonary	300 Polaris Parkway	Westerville	OH	Terminated
DSH360017Q	Child	DSH	GRANT MEDICAL CENTER	OHWED Diagnostics	300 Polaris Parkway	Westerville	OH	Active
DSH360017R	Child	DSH	GRANT MEDICAL CENTER	Westerville Imaging	300 Polaris Parkway	Westerville	OH	Active
DSH360017S	Child	DSH	GRANT MEDICAL CENTER	PMH Emergency Department	1010 Refugee Road	Pickerington	OH	Active
DSH360017T	Child	DSH	GRANT MEDICAL CENTER	PMH - Imaging	1010 Refugee Road	Pickerington	OH	Active
DSH360017U	Child	DSH	GRANT MEDICAL CENTER	Hilliard Emergency Department - Emergency	3880 Fishinger Blvd	Hilliard	OH	Active
DSH360017V	Child	DSH	GRANT MEDICAL CENTER	Obetz Emergency Department - Emergency	4335 Alum Creek Drive	Columbus	OH	Active
DSH360017W	Child	DSH	GRANT MEDICAL CENTER	Powell Emergency Department - Emergency	4141 North Hampton Drive	Powell	OH	Active
DSH360017X	Child	DSH	GRANT MEDICAL CENTER	New Albany Emergency Department - Emergency	5868 North Hamilton Road	New Albany	OH	Active
DSH360017Y	Child	DSH	GRANT MEDICAL CENTER	Reynoldsburg Emergency Department - Emergency	6960 East Main Street	Reynoldsburg	OH	Active
DSH360017Z	Child	DSH	GRANT MEDICAL CENTER	Westerville Cardiac Imaging - Cardiology	260 Polaris Parkway	Westerville	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Mccallister, Brian Director of Finance OhioHealth 6145444154	Halpin, Jean President OhioHealth 6145668952	4/15/2025 9:53 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 4:47:15 PM	9/3/2024 10:02:20 AM	9/3/2024 10:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/7/2024 8:58 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0030254	4/7/2024 8:58 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	4/7/2024 8:58 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1699553891	4/7/2024 8:58 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	4/7/2024 8:58 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:46:03 AM	8/25/2023 4:47:15 PM	8/25/2023 4:47 PM
Contacts	Authorizing Official	Update	Change Request	Bushiri, Gaston VP Finance OhioHealth 6149552002	Mccallister, Brian Director of Finance OhioHealth 6145444154	4/17/2023 10:56 AM
Contacts	Primary Contact	Update	Group Change Request	Smith, Timothy Director of Pharmacy OhioHealth 6145669249	Prier, Beth Director Pharmacy Operations OhioHealth 6145669249	3/27/2023 7:51 AM
Details	Last Recertification Date	Update	Recertification		9/1/2022 10:46:03 AM	9/1/2022 10:46 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Bushiri, Gaston VP Finance OhioHealth 6149552002	11/9/2021 7:58 AM
Details	340B ID	Update	New Registration		DSH360017AN	11/9/2021 7:58 AM
Details	Entity Subname	Update	New Registration	Bone and Joint Ambulatory	Bone and Joint Ambulatory - Ambulatory Surgery	11/9/2021 7:58 AM
Dates	Participating Approval Date	Update	New Registration		11/9/2021 7:58:54 AM	11/9/2021 7:58 AM
Details	State	Update	New Registration	Pending	Approved	11/9/2021 7:58 AM
Dates	Signed By Date	Update	New Registration		11/8/2021 3:59:41 PM	11/9/2021 7:58 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/9/2021 7:58 AM
Addresses	Main Address	Insert	New Registration		323 E Town St Columbus, OH 43215	10/12/2021 3:06 PM
Addresses	Billing Address	Insert	New Registration		OhioHealth PO Box 9 Columbus, OH 43216	10/12/2021 3:06 PM
Addresses	Shipping Address	Insert	New Registration		Grant Medical Center 111 South Grant Ave Columbus, OH 43215	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		3359253	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0419074	10/12/2021 3:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/12/2021 3:06 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1255377149	10/12/2021 3:06 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/12/2021 3:06 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427673185	10/12/2021 3:06 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/12/2021 3:06 PM
Contacts	Primary Contact	Insert	New Registration		Smith, Timothy Director of Pharmacy OhioHealth 6145669249	10/12/2021 3:06 PM
Contacts	Authorizing Official	Insert	New Registration		Bushiri, Gaston VP Finance OhioHealth 6149552002	10/12/2021 3:06 PM
Details	Assistance Received From Date	Insert	New Registration			10/12/2021 3:06 PM
Details	Assistance Received To Date	Insert	New Registration			10/12/2021 3:06 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2021 3:06 PM
Details	Grant Number	Insert	New Registration			10/12/2021 3:06 PM
Details	340B ID	Insert	New Registration			10/12/2021 3:06 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2021 3:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2021 3:06 PM
Details	Medicare Provider Number	Insert	New Registration		360017	10/12/2021 3:06 PM
Details	Entity Name	Insert	New Registration		GRANT MEDICAL CENTER	10/12/2021 3:06 PM
Details	NOFO Number	Insert	New Registration			10/12/2021 3:06 PM
Details	Program Code	Insert	New Registration		DSH	10/12/2021 3:06 PM
Details	Entity Subname	Insert	New Registration		Bone and Joint Ambulatory	10/12/2021 3:06 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2021 3:06 PM
Details	State	Insert	New Registration		Pending	10/12/2021 3:06 PM
Dates	Registration Date	Insert	New Registration		10/12/2021 3:06:54 PM	10/12/2021 3:06 PM
Dates	Signed By Date	Insert	New Registration			10/12/2021 3:06 PM
Dates	Start Date	Insert	New Registration			10/12/2021 3:06 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2021 3:06 PM
Terminations	Termination Date	Insert	New Registration			10/12/2021 3:06 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2021 3:06 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2021 3:06 PM