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DSH360017F GRANT MEDICAL CENTER (Terminated)
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Main Details
Name
GRANT MEDICAL CENTER
Subdivision Name
Trauma Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360017F
Medicare Provider Number
360017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/17/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/19/2012
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
OhioHealth
Gaston Bushiri, VP Finance
(614) 955-2002
Primary Contact
OhioHealth
Jeffrey Cook, Director of Pharmacy
(614) 566-9054
Addresses
Street Address
340 E Town St
Columbus, OH 43215
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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