Covered Entity Details

CAN050146-28 CITY OF HOPE NATIONAL MEDICAL CENTER (Approved) - information as of 5/13/2025 1:36:04 AM

Main Details

Name

CITY OF HOPE NATIONAL MEDICAL CENTER

Subdivision Name

CITY OF HOPE SEACLIFF - SEACLIFF NMC INFUSION

Type

Free Standing Cancer Hospital

Rural

340B ID

CAN050146-28

Medicare Provider Number

050146

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/4/2025

Last Recertification Date

Contacts

Authorizing Official

City of Hope
Wafa Samara, CPO
(626) 218-4936

Primary Contact

City of Hope
Jamie Jove Lee, Director, 340B Program
(626) 218-3236

Addresses

Street Address

2100 MAIN STREET STE 300
HUNTINGTON BEACH, CA 92648

Billing Address

CITY OF HOPE NATIONAL MEDICAL CENTER
1500 E. DUARTE ROAD
DUARTE, CA 91010

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
CA	ZZT40146F,PHB185180	1346283140,1750358297,1508597626
NV		1346283140,1750358297,1508597626

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
CAN050146-01	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE NATIONAL MEDICAL CENTE - CITY OF HOPE UPLAND	1100 SAN BERNARDINO RD	UPLAND	CA	Active
CAN050146-02	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE NATIONAL MEDICAL CENTE - CITY OF HOPE CORONA	320 W 6TH ST	CORONA	CA	Active
CAN050146-03	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE NATIONAL MEDICAL CENTE - City of Hope Lennar Oncology/Infusion	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-04	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC OP PRE AND POST OP	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-05	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ARCADIA - ARCADIA NMC RADIATION ONCOLOGY	301 W. HUNTINGTON DR.	ARCADIA	CA	Active
CAN050146-06	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC INTERVENTIONAL RADIOLOGY	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-07	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE UPLAND - UPLAND NMC INFUSION	1100 SAN BERNARDINO RD	UPLAND	CA	Active
CAN050146-08	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE CORONA - CORONA NMC CLINIC	320 W. 6TH ST	CORONA	CA	Active
CAN050146-09	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC RADIATION ONCOLOGY	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-10	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE CORONA - CORONA NMC IMAGING	320 W. 6TH ST	CORONA	CA	Active
CAN050146-11	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC VASCULAR ACCESS DEV	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-12	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE UPLAND - UPLAND NMC CLINIC	1100 SAN BERNARDINO RD	UPLAND	CA	Terminated
CAN050146-13	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC MRI	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-14	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC MAIN CLINIC	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-15	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC INFUSION	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-16	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC BREAST SCREENING & DIAG	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-17	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC DIAGNOSTIC RADIOLOGY	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-18	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC NUCLEAR MEDICINE	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-19	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC CAT SCAN	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-20	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC OP OPERATING ROOM	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-21	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC ULTRASOUND	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-22	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC REHAB	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-23	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC CLINICAL RESEARCH INFUSION	1000 FIVEPOINT	IRVINE	CA	Active
CAN050146-24	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE CORONA - CORONA NMC RADIATION	320 W. 6TH ST	CORONA	CA	Active
CAN050146-25	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE UPLAND - UPLAND NMC RADIATION	1100 SAN BERNARDINO RD	UPLAND	CA	Active
CAN050146-26	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE ORANGE COUNTY - OC NMC HEM/HCT DAY HOSPITAL	1000 FIVEPOINT	IRVINE	CA	Approved
CAN050146-27	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE SEACLIFF - SEACLIFF NMC CLINIC	2100 MAIN STREET STE 300	HUNTINGTON BEACH	CA	Approved
CAN050146-28	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE SEACLIFF - SEACLIFF NMC INFUSION	2100 MAIN STREET STE 300	HUNTINGTON BEACH	CA	Approved
CAN050146-29	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE SOUTH BAY - SOUTH BAY NMC CLINIC	5215 TORRANCE BLVD #200	TORRANCE	CA	Approved
CAN050146-30	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE SOUTH BAY - SOUTH BAY NMC RADIATION	5215 TORRANCE BLVD #100	TORRANCE	CA	Approved
CAN050146-31	Child	CAN	CITY OF HOPE NATIONAL MEDICAL CENTER	CITY OF HOPE SOUTH BAY - SOUTH BAY NMC INFUSION	5215 TORRANCE BLVD #200	TORRANCE	CA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Samara, Wafa CPO City of Hope 6262184936	4/4/2025 2:12 PM
Details	340B ID	Update	New Registration		CAN050146-28	4/4/2025 2:12 PM
Details	Entity Subname	Update	New Registration	CITY OF HOPE SEACLIFF	CITY OF HOPE SEACLIFF - SEACLIFF NMC INFUSION	4/4/2025 2:12 PM
Dates	Participating Approval Date	Update	New Registration		4/4/2025 2:12:17 PM	4/4/2025 2:12 PM
Details	State	Update	New Registration	Pending	Approved	4/4/2025 2:12 PM
Dates	Signed By Date	Update	New Registration		4/4/2025 5:38:05 AM	4/4/2025 2:12 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/4/2025 2:12 PM
Addresses	Main Address	Insert	New Registration		2100 MAIN STREET STE 300 HUNTINGTON BEACH, CA 92648	4/1/2025 9:27 PM
Addresses	Billing Address	Insert	New Registration		CITY OF HOPE NATIONAL MEDICAL CENTER 1500 E. DUARTE ROAD DUARTE, CA 91010	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		ZZT40146F	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		PHB185180	4/1/2025 9:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346283140	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750358297	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508597626	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346283140	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		NV	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750358297	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		NV	4/1/2025 9:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508597626	4/1/2025 9:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		NV	4/1/2025 9:27 PM
Contacts	Primary Contact	Insert	New Registration		Lee, Jamie Jove Director, 340B Program City of Hope 6262183236	4/1/2025 9:27 PM
Contacts	Authorizing Official	Insert	New Registration		Samara, Wafa CPO City of Hope 6262184936	4/1/2025 9:27 PM
Details	Assistance Received From Date	Insert	New Registration			4/1/2025 9:27 PM
Details	Assistance Received To Date	Insert	New Registration			4/1/2025 9:27 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2025 9:27 PM
Details	Grant Number	Insert	New Registration			4/1/2025 9:27 PM
Details	340B ID	Insert	New Registration			4/1/2025 9:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2025 9:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2025 9:27 PM
Details	Medicare Provider Number	Insert	New Registration		050146	4/1/2025 9:27 PM
Details	Entity Name	Insert	New Registration		CITY OF HOPE NATIONAL MEDICAL CENTER	4/1/2025 9:27 PM
Details	NOFO Number	Insert	New Registration			4/1/2025 9:27 PM
Details	Program Code	Insert	New Registration		CAN	4/1/2025 9:27 PM
Details	Entity Subname	Insert	New Registration		CITY OF HOPE SEACLIFF	4/1/2025 9:27 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2025 9:27 PM
Details	State	Insert	New Registration		Pending	4/1/2025 9:27 PM
Dates	Registration Date	Insert	New Registration		4/1/2025 9:27:18 PM	4/1/2025 9:27 PM
Dates	Signed By Date	Insert	New Registration			4/1/2025 9:27 PM
Dates	Start Date	Insert	New Registration			4/1/2025 9:27 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2025 9:27 PM
Terminations	Termination Date	Insert	New Registration			4/1/2025 9:27 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2025 9:27 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2025 9:27 PM