| Details | Last Recertification Date | Update | Recertification | 2/7/2024 10:05:53 AM | 2/13/2025 10:06:02 AM | 2/13/2025 10:06 AM |
| Contacts | Primary Contact | Update | AO Change Request | Wishart, Bibi
Program Director, 340B
North Carolina Baptist Hospital
3367133426 | Wishart, Bibi W
Program Director, 340B
North Carolina Baptist Hospital
3367133426 | 9/30/2024 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 3:08:10 PM | 2/7/2024 10:05:53 AM | 2/7/2024 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 2:47:37 PM | 1/30/2023 3:08:10 PM | 1/30/2023 3:08 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Wishart, Bibi
System Manager, 340B
North Carolina Baptist Hospital
3367133426 | Wishart, Bibi
Program Director, 340B
North Carolina Baptist Hospital
3367133426 | 1/10/2023 4:36 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 8:42:56 AM | 2/1/2022 2:47:37 PM | 2/1/2022 2:47 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | NC | 2/3/2021 8:42 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 11:52:59 AM | 2/3/2021 8:42:56 AM | 2/3/2021 8:42 AM |
| Contacts | Authorizing Official | Update | Change Request | Emmerich, Conrad
Sr. Vice President,Hospital & Business Services
North Carolina Baptist Hospital
3367168941 | Waid, Michael Thomas
Sr Vice President - Health System Operations and Integration
North Carolina Baptist Hospital
3367160433 | 11/18/2020 8:19 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 1:51:54 PM | 1/28/2020 11:52:59 AM | 1/28/2020 11:52 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wishart, Bibi
Interim Assistant Director
North Carolina Baptist Hospital
3367133426 | Wishart, Bibi
System Manager, 340B
North Carolina Baptist Hospital
3367133426 | 6/3/2019 12:07 PM |
| Details | Last Recertification Date | Update | Recertification | 2/28/2018 3:17:01 PM | 1/29/2019 1:51:54 PM | 1/29/2019 1:51 PM |
| Contacts | Primary Contact | Update | Change Request | Konopko, Martin
System Manager 340b
NORTH CAROLINA BAPTIST HOSPITAL
3367139418 | Wishart, Bibi
Interim Assistant Director
North Carolina Baptist Hospital
3367133426 | 1/9/2019 10:49 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Emmerich, Conrad
Sr. Vice President,Hospital & Business Services
North Carolina Baptist Hospital dba Wake Forest Baptist Medical Center
3367168941 | Emmerich, Conrad
Sr. Vice President,Hospital & Business Services
North Carolina Baptist Hospital
3367168941 | 8/21/2018 8:56 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Konopko, Martin
System Manager 340b
NORTH CAROLINA BAPTIST HOSPITAL dba Wake Forest Baptist Medical Center
3367139418 | Konopko, Martin
System Manager 340b
NORTH CAROLINA BAPTIST HOSPITAL
3367139418 | 8/6/2018 1:58 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2017 12:00:00 AM | 2/28/2018 3:17:01 PM | 2/28/2018 3:17 PM |
| Contacts | Authorizing Official | Update | AO Change Request | High, Kevin P.
Executive Vice President, Health Systems Affairs
Wake Forest Baptist
3367166211 | Emmerich, Conrad
Sr. Vice President,Hospital & Business Services
North Carolina Baptist Hospital dba Wake Forest Baptist Medical Center
3367168941 | 1/29/2018 9:28 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Konopko, Martin
System Manager 340b
Wake Forest Baptist Health
3367139418 | Konopko, Martin
System Manager 340b
NORTH CAROLINA BAPTIST HOSPITAL dba Wake Forest Baptist Medical Center
3367139418 | 11/13/2017 12:04 PM |
| Contacts | Primary Contact | Update | Change Request | Orsborn, Adam
Director or Pharmacy, Operations and Finance
3367166267 | Konopko, Martin
System Manager 340b
Wake Forest Baptist Health
3367139418 | 10/1/2017 11:41 AM |
| Contacts | Authorizing Official | Update | Change Request | High, Kevin P.
Executive Vice President, Health Systems Affairs
3367166211 | High, Kevin P.
Executive Vice President, Health Systems Affairs
Wake Forest Baptist
3367166211 | 9/29/2017 1:12 PM |
| Contacts | Authorizing Official | Update | | Carbone, Karen B.
President, COO
3367166211 | High, Kevin P.
Executive Vice President, Health Systems Affairs
3367166211 | 8/14/2017 2:34 PM |
| Addresses | Main Address | Insert | | |
MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157 | 6/20/2017 8:06 AM |
| Details | Last Recertification Date | Update | | 2/29/2016 12:00:00 AM | 2/7/2017 12:00:00 AM | 2/7/2017 8:42 AM |
| Details | Last Recertification Date | Update | | 3/9/2015 12:00:00 AM | 2/29/2016 12:00:00 AM | 2/29/2016 7:44 AM |
| Contacts | Primary Contact | Update | | SMITH, ANITA
COORDINATOR HEMOPHILIA TREATMENT CENTER
3367164324 | Orsborn, Adam
Director or Pharmacy, Operations and Finance
3367166267 | 4/27/2015 4:04 PM |
| Contacts | Authorizing Official | Update | | Sintich, Maureen E.
VP Operations, Chief Nursing Officer
3367163424 | Carbone, Karen B.
President, COO
3367166211 | 3/9/2015 10:13 AM |
| Details | Last Recertification Date | Update | | 3/13/2014 12:00:00 AM | 3/9/2015 12:00:00 AM | 3/9/2015 10:13 AM |
| Contacts | Authorizing Official | Update | | WOFFORD, MARCIA M.
DIRECTOR PEDIATRIC HEMATOLOGY-ONCOLOGY AND VICE CHAIR PEDIATRIC
3367164085 | Sintich, Maureen E.
VP Operations, Chief Nursing Officer
3367163424 | 6/17/2014 5:12 PM |
| Details | Grant Number | Update | | H30MC05053 | H30MC24046 | 6/17/2014 5:12 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1164634952 | 3/13/2014 9:06 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/13/2014 12:00:00 AM | 3/13/2014 9:06 AM |
| Contacts | Primary Contact | Update | | SMITH, ANITA
COORDINATOR HEMOPHILIA TREATMENT CENTER
3367164324 | SMITH, ANITA
COORDINATOR HEMOPHILIA TREATMENT CENTER
3367164324 | 2/14/2013 11:12 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/14/2013 11:12 AM |
| Dates | Registration Date | Update | | | 10/22/2008 12:00:00 AM | 2/14/2013 11:12 AM |
| Contacts | Primary Contact | Insert | | | SMITH, ANITA
COORDINATOR HEMOPHILIA TREATMENT CENTER
3367164324 | 10/22/2008 1:09 PM |
| Contacts | Authorizing Official | Insert | | | WOFFORD, MARCIA M.
DIRECTOR PEDIATRIC HEMATOLOGY-ONCOLOGY AND VICE CHAIR PEDIATRIC
3367164085 | 10/22/2008 1:09 PM |
| Dates | Registration Date | Update | | 10/22/2008 12:00:00 AM | | 10/22/2008 1:09 PM |
| Details | Last Recertification Date | Insert | | | | 10/22/2008 1:06 PM |
| Details | Grant Number | Insert | | | H30MC05053 | 10/22/2008 1:06 PM |
| Details | 340B ID | Insert | | | HM27157 | 10/22/2008 1:06 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/22/2008 1:06 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/22/2008 1:06 PM |
| Details | Medicare Provider Number | Insert | | | | 10/22/2008 1:06 PM |
| Details | Entity Name | Insert | | | WAKE FOREST UNIVERSITY HEALTH SCIENCES | 10/22/2008 1:06 PM |
| Details | Program Code | Insert | | | HM | 10/22/2008 1:06 PM |
| Details | Entity Subname | Insert | | | | 10/22/2008 1:06 PM |
| Dates | Participating Approval Date | Insert | | | 10/22/2008 12:00:00 AM | 10/22/2008 1:06 PM |
| Details | State | Insert | | | Active | 10/22/2008 1:06 PM |
| Dates | Registration Date | Insert | | | 10/22/2008 12:00:00 AM | 10/22/2008 1:06 PM |
| Dates | Signed By Date | Insert | | | 9/1/2008 12:00:00 AM | 10/22/2008 1:06 PM |
| Dates | Start Date | Insert | | | 1/1/2009 12:00:00 AM | 10/22/2008 1:06 PM |
| Terminations | Termination Comments | Insert | | | | 10/22/2008 1:06 PM |
| Terminations | Termination Date | Insert | | | | 10/22/2008 1:06 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/22/2008 1:06 PM |
| Terminations | Termination Reason | Insert | | | | 10/22/2008 1:06 PM |