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HOMEREACH
DSH360017E GRANT MEDICAL CENTER
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Covered Entity Details
Entity Name
GRANT MEDICAL CENTER
Subdivision Name
Infusion Center
Type
Disproportionate Share Hospital
340B ID
DSH360017E
Entity Address
303 E. Town St
Columbus, OH 43215
Medicare Provider Number
360017
Outpatient Facility Provider Number
Participating Start Date
7/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HOMEREACH
Pharmacy Address
DBA OHIOHEALTH INFUSION PHARMACY
404 E WILSON BRIDGE RD STE B
WORTHINGTON, OH 43085-2369
Pharmacy Comments
Contract Details
Approval Date
12/4/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joe Abel, Controller, Grant Hospital
(614) 544-4112
Contract Pharmacy Representative
Joe Pietrusik, VP Operations , HomeReach
(614) 566-0705
Signed By Date
10/15/2012
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