Covered Entity Details

RRC490093-13 SENTARA CAREPLEX HOSPITAL (Active) - information as of 5/8/2025 10:16:34 PM

Main Details

Name

SENTARA CAREPLEX HOSPITAL

Subdivision Name

SENTARA FAMILY MEDICINE PHYSICIANS - Family Medicine - Port Warwick I

Type

Rural Referral Center

Rural

Yes

340B ID

RRC490093-13

Medicare Provider Number

490093

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/2/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/9/2024

Last Recertification Date

Contacts

Authorizing Official

Vice President of Operations
Michael McKendall, Vice President of Operations
(757) 736-2655

Primary Contact

Sentara Careplex Hospital
June Javier, Pharmacy Manager
(757) 736-1216

Addresses

Street Address

11803 JEFFERSON AVE
STE 100
NEWPORT NEWS, VA 23606-4390

Billing Address

Sentara Careplex Hospital
1300 Sentara Park
Virginia Beach, VA 23464

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
NC		1467589234
VA		1467589234

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
RRC490093-01	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Wound Healing and Hyperbaric Center - Port Warwick I	11803 Jefferson Avenue	Newport News	VA	Terminated
RRC490093-02	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Endocrinology Specialists - MOB	4001 Coliseum Drive	Hampton	VA	Active
RRC490093-03	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Advanced Imaging Center - Sentara Port Warwick II	1031 Loftis Boulevard	Newport News	VA	Active
RRC490093-04	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Cardiology Specialists - Port Warwick I	11803 Jefferson Avenue	Newport News	VA	Active
RRC490093-05	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Comprehensive Breast Center - Port Warwick I	11803 Jefferson Avenue	Newport News	VA	Terminated
RRC490093-06	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Pain Management Specialists - MOB	4000 Coliseum Drive	Hampton	VA	Active
RRC490093-07	Child	RRC	SENTARA CAREPLEX HOSPITAL	Sentara Nuclear Medicine - Sentara Port Warwick II	1031 Loftis Boulevard	Newport News	VA	Active
RRC490093-08	Child	RRC	SENTARA CAREPLEX HOSPITAL	Emergency Department - Port Warwick II - Emergency Department	1031 Loftis Boulevard	Newport News	VA	Active
RRC490093-09	Child	RRC	SENTARA CAREPLEX HOSPITAL	SENTARA FAMILY MEDICINE - Family Medicine - Old Hampton	200 EATON ST	HAMPTON	VA	Active
RRC490093-10	Child	RRC	SENTARA CAREPLEX HOSPITAL	SENTARA FAMILY MEDICINE - Family Medicine - Peninsula Towne	2104 EXECUTIVE DR	HAMPTON	VA	Active
RRC490093-11	Child	RRC	SENTARA CAREPLEX HOSPITAL	Family & Internal Medicine - Careplex West - Family & Internal Medicine - Careplex West	4001 Coliseum Drive	Hampton	VA	Active
RRC490093-12	Child	RRC	SENTARA CAREPLEX HOSPITAL	Pulmonary & Critical Care - Pulmonary & Critical Care Careplex	4000 Coliseum Drive	Hampton	VA	Active
RRC490093-13	Child	RRC	SENTARA CAREPLEX HOSPITAL	SENTARA FAMILY MEDICINE PHYSICIANS - Family Medicine - Port Warwick I	11803 JEFFERSON AVE	NEWPORT NEWS	VA	Active
RRC490093-14	Child	RRC	SENTARA CAREPLEX HOSPITAL	SENTARA INTERNAL MEDICINE PHYSICIAN - Port Warwick 1 - Internal Medicine	11803 Jefferson Avenue	NEWPORT NEWS	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Conley, Kapua Regional President Sentara CarePlex Hospital 7577362655	McKendall, Michael Vice President of Operations Vice President of Operations 7577362655	12/5/2024 6:49 AM
Contacts	Signed By	Insert	New Registration		Conley, Kapua Regional President Sentara CarePlex Hospital 7577362655	10/9/2024 10:01 AM
Details	340B ID	Update	New Registration		RRC490093-13	10/9/2024 10:01 AM
Details	Entity Subname	Update	New Registration	SENTARA FAMILY MEDICINE PHYSICIANS	SENTARA FAMILY MEDICINE PHYSICIANS - Family Medicine - Port Warwick I	10/9/2024 10:01 AM
Dates	Participating Approval Date	Update	New Registration		10/9/2024 10:01:47 AM	10/9/2024 10:01 AM
Details	State	Update	New Registration	Pending	Approved	10/9/2024 10:01 AM
Dates	Signed By Date	Update	New Registration		10/7/2024 7:38:50 AM	10/9/2024 10:01 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/9/2024 10:01 AM
Addresses	Main Address	Insert	New Registration		11803 JEFFERSON AVE STE 100 NEWPORT NEWS, VA 23606-4390	10/2/2024 1:35 PM
Addresses	Billing Address	Insert	New Registration		Sentara Careplex Hospital 1300 Sentara Park Virginia Beach, VA 23464	10/2/2024 1:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467589234	10/2/2024 1:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/2/2024 1:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467589234	10/2/2024 1:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/2/2024 1:35 PM
Contacts	Authorizing Official	Insert	New Registration		Conley, Kapua Regional President Sentara CarePlex Hospital 7577362655	10/2/2024 1:35 PM
Contacts	Primary Contact	Insert	New Registration		Javier, June Pharmacy Manager Sentara Careplex Hospital 7577361216	10/2/2024 1:35 PM
Details	Assistance Received From Date	Insert	New Registration			10/2/2024 1:35 PM
Details	Assistance Received To Date	Insert	New Registration			10/2/2024 1:35 PM
Details	Last Recertification Date	Insert	New Registration			10/2/2024 1:35 PM
Details	Grant Number	Insert	New Registration			10/2/2024 1:35 PM
Details	340B ID	Insert	New Registration			10/2/2024 1:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2024 1:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2024 1:35 PM
Details	Medicare Provider Number	Insert	New Registration		490093	10/2/2024 1:35 PM
Details	Entity Name	Insert	New Registration		SENTARA CAREPLEX HOSPITAL	10/2/2024 1:35 PM
Details	NOFO Number	Insert	New Registration			10/2/2024 1:35 PM
Details	Program Code	Insert	New Registration		RRC	10/2/2024 1:35 PM
Details	Entity Subname	Insert	New Registration		SENTARA FAMILY MEDICINE PHYSICIANS	10/2/2024 1:35 PM
Dates	Participating Approval Date	Insert	New Registration			10/2/2024 1:35 PM
Details	State	Insert	New Registration		Pending	10/2/2024 1:35 PM
Dates	Registration Date	Insert	New Registration		10/2/2024 1:35:11 PM	10/2/2024 1:35 PM
Dates	Signed By Date	Insert	New Registration			10/2/2024 1:35 PM
Dates	Start Date	Insert	New Registration			10/2/2024 1:35 PM
Terminations	Termination Comments	Insert	New Registration			10/2/2024 1:35 PM
Terminations	Termination Date	Insert	New Registration			10/2/2024 1:35 PM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2024 1:35 PM
Terminations	Termination Reason	Insert	New Registration			10/2/2024 1:35 PM