Covered Entity Details

RRC490120-18 CHESAPEAKE GENERAL HOSPITAL (Terminated) - information as of 6/2/2025 8:26:01 AM

Main Details

Name

CHESAPEAKE GENERAL HOSPITAL

Subdivision Name

CHESAPEAKE REGIONAL PC-SUFFOLK - CRMC - Harbour View

Type

Rural Referral Center

Rural

Yes

340B ID

RRC490120-18

Medicare Provider Number

490120

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/9/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/23/2024

Last Recertification Date

8/19/2024

Termination Date
Termination Reason

1/1/2025
DSH percentage below statutory minimum

Contacts

Authorizing Official

Chesapeake General Hospital
Reese Jackson, President and CEO
(757) 312-8121

Primary Contact

Chesapeake General Hospital
Yao-Hua Lin, Director of Pharmacy
(757) 312-6168

Addresses

Street Address

5849 HARBOUR VIEW BLVD
STE 250
SUFFOLK, VA 23435-3769

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
VA	1700896354	1700896354
NC	1700896354	1700896354

Shipping Addresses

Same as Street Address

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
RRC490120-01	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Sleep Lab - Chesapeake - Sleep Lab	800 Battlefield Boulevard North	Chesapeake	VA	Terminated
RRC490120-02	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Jennings Outpatient Center - CT Scan	844 N Battlefield Boulevard	Chesapeake	VA	Terminated
RRC490120-03	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Cancer Center - Outpatient Infusion	744 N Battlefield Boulevard	Chesapeake	VA	Terminated
RRC490120-04	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Home Health - Home Health	667 Kingsborough Square	Chesapeake	VA	Terminated
RRC490120-05	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Hospice - Hospice	667 Kingsborough Square	Chesapeake	VA	Terminated
RRC490120-06	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Sleep Lab - Elizabeth City - Sleep Lab	1805 W City Drive	Elizabeth City	NC	Terminated
RRC490120-07	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Jennings Outpatient Center - MRI	844 N Battlefield Boulevard	Chesapeake	VA	Terminated
RRC490120-08	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Jennings Outpatient Center - Radiology	844 N Battlefield Boulevard	Chesapeake	VA	Terminated
RRC490120-09	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Wound Care - Elizabeth City - Wound Care	1805 W City Drive	Elizabeth City	NC	Terminated
RRC490120-10	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	Transitional Care Clinic - Transitional Care	800 Battlefield Boulevard North	Chesapeake	VA	Terminated
RRC490120-11	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC PRIMARY CARE GRASSFIELD - Grassfield Primary Care Clinic	648 GRASSFIELD PKWY	CHESAPEAKE	VA	Terminated
RRC490120-12	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC PRIMARY CARE GREENBRIER - Greenbrier Primary Care Clinic	908 EDEN WAY N	CHESAPEAKE	VA	Terminated
RRC490120-13	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC NEUROSCIENCES - Neurology	300 MEDICAL PKWY	CHESAPEAKE	VA	Terminated
RRC490120-14	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC CARDIOLOGY - Cardiology Clinic	111 Medical Pkwy	Chesapeake	VA	Terminated
RRC490120-15	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC PULMONOLOGY - Pulmonology Clinic	300 Medical Pkwy	Chesapeake	VA	Terminated
RRC490120-16	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC PAIN MANAGEMENT - Pain Management	300 MEDICAL PKWY	CHESAPEAKE	VA	Terminated
RRC490120-17	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CRMC - Infectious Disease - Infectious Diseases Clinic	111 Medical Parkway	Chesapeake	VA	Terminated
RRC490120-18	Child	RRC	CHESAPEAKE GENERAL HOSPITAL	CHESAPEAKE REGIONAL PC-SUFFOLK - CRMC - Harbour View	5849 HARBOUR VIEW BLVD	SUFFOLK	VA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/2/2024 12:00:00 AM	12/4/2024 10:57 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2024 10:57 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/4/2024 10:57 AM
Terminations	Termination Effective Date	Update	Termination Request		12/2/2024 12:00:00 AM	12/4/2024 10:57 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/4/2024 10:57 AM
Contacts	Primary Contact	Update	Profile Change Request	Lin, Yao-Hua Interim Director of Pharmacy Chesapeake General Hospital 7573126349	Lin, Yao-Hua Director of Pharmacy Chesapeake General Hospital 7573126168	12/3/2024 11:14 AM
Details	Last Recertification Date	Update	Recertification		8/19/2024 2:20:19 PM	8/19/2024 2:20 PM
Contacts	Primary Contact	Update	Profile Change Request	lin, Yao-hua Interim Director of Pharmacy Chesapeake General Hospital 7573126349	Lin, Yao-Hua Interim Director of Pharmacy Chesapeake General Hospital 7573126349	8/14/2024 10:32 AM
Contacts	Primary Contact	Update	Change Request	Schultz, Amy E Director of Pharmacy Chesapeake General Hospital 7573126168	lin, Yao-hua Interim Director of Pharmacy Chesapeake General Hospital 7573126349	8/6/2024 3:00 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Jackson, Reese President and CEO Chesapeake General Hospital 7573128121	4/23/2024 8:44 AM
Details	340B ID	Update	New Registration		RRC490120-18	4/23/2024 8:44 AM
Details	Entity Subname	Update	New Registration	CHESAPEAKE REGIONAL PC-SUFFOLK	CHESAPEAKE REGIONAL PC-SUFFOLK - CRMC - Harbour View	4/23/2024 8:44 AM
Dates	Participating Approval Date	Update	New Registration		4/23/2024 8:44:26 AM	4/23/2024 8:44 AM
Details	State	Update	New Registration	Pending	Approved	4/23/2024 8:44 AM
Dates	Signed By Date	Update	New Registration		4/13/2024 11:58:55 AM	4/23/2024 8:44 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/23/2024 8:44 AM
Addresses	Main Address	Insert	New Registration		5849 HARBOUR VIEW BLVD STE 250 SUFFOLK, VA 23435-3769	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1700896354	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1700896354	4/9/2024 4:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	4/9/2024 4:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1700896354	4/9/2024 4:32 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	4/9/2024 4:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1700896354	4/9/2024 4:32 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	4/9/2024 4:32 PM
Contacts	Primary Contact	Insert	New Registration		Schultz, Amy E Director of Pharmacy Chesapeake General Hospital 7573126168	4/9/2024 4:32 PM
Contacts	Authorizing Official	Insert	New Registration		Jackson, Reese President and CEO Chesapeake General Hospital 7573128121	4/9/2024 4:32 PM
Details	Assistance Received From Date	Insert	New Registration			4/9/2024 4:32 PM
Details	Assistance Received To Date	Insert	New Registration			4/9/2024 4:32 PM
Details	Last Recertification Date	Insert	New Registration			4/9/2024 4:32 PM
Details	Grant Number	Insert	New Registration			4/9/2024 4:32 PM
Details	340B ID	Insert	New Registration			4/9/2024 4:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/9/2024 4:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/9/2024 4:32 PM
Details	Medicare Provider Number	Insert	New Registration		490120	4/9/2024 4:32 PM
Details	Entity Name	Insert	New Registration		CHESAPEAKE GENERAL HOSPITAL	4/9/2024 4:32 PM
Details	NOFO Number	Insert	New Registration			4/9/2024 4:32 PM
Details	Program Code	Insert	New Registration		RRC	4/9/2024 4:32 PM
Details	Entity Subname	Insert	New Registration		CHESAPEAKE REGIONAL PC-SUFFOLK	4/9/2024 4:32 PM
Dates	Participating Approval Date	Insert	New Registration			4/9/2024 4:32 PM
Details	State	Insert	New Registration		Pending	4/9/2024 4:32 PM
Dates	Registration Date	Insert	New Registration		4/9/2024 4:32:10 PM	4/9/2024 4:32 PM
Dates	Signed By Date	Insert	New Registration			4/9/2024 4:32 PM
Dates	Start Date	Insert	New Registration			4/9/2024 4:32 PM
Terminations	Termination Comments	Insert	New Registration			4/9/2024 4:32 PM
Terminations	Termination Date	Insert	New Registration			4/9/2024 4:32 PM
Terminations	Termination Effective Date	Insert	New Registration			4/9/2024 4:32 PM
Terminations	Termination Reason	Insert	New Registration			4/9/2024 4:32 PM