340B Drug Pricing Program Database


CAN050146-00 CITY OF HOPE NATIONAL MEDICAL CENTER (Active) - information as of 4/29/2025 11:58:09 PM

Main Details
CITY OF HOPE NATIONAL MEDICAL CENTER
Free Standing Cancer Hospital
No
CAN050146-00
050146


Additional Details
Active
8/22/2010
9/1/2010
8/30/2010
8/27/2024

Contacts

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

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

Addresses

1500 E. DUARTE ROAD
DUARTE, CA 91010

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CAZZT40146F,PHB1851801346283140,1750358297,1568867240
AL 1346283140,1750358297,1568867240
AK 1346283140,1750358297,1568867240
AZ 1346283140,1750358297,1568867240
CO 1346283140,1750358297,1568867240
CT 1346283140,1750358297,1568867240
DE 1346283140,1750358297,1568867240
DC 1346283140,1750358297,1568867240
FL 1346283140,1750358297,1568867240
GA 1346283140,1750358297,1568867240
HI 1346283140,1750358297,1568867240
ID 1346283140,1750358297,1568867240
IL 1346283140,1750358297,1568867240
IN 1346283140,1750358297,1568867240
IA 1346283140,1750358297,1568867240
KS 1346283140,1750358297,1568867240
KY 1346283140,1750358297,1568867240
LA 1346283140,1750358297,1568867240
ME 1346283140,1750358297,1568867240
MD 1346283140,1750358297,1568867240
MA 1346283140,1750358297,1568867240
MI 1346283140,1750358297,1568867240
MN 1346283140,1750358297,1568867240
MS 1346283140,1750358297,1568867240
MO 1346283140,1750358297,1568867240
MT 1346283140,1750358297,1568867240
NE 1346283140,1750358297,1568867240
NV 1346283140,1750358297,1568867240
NJ 1346283140,1750358297,1568867240
NM 1346283140,1750358297,1568867240
NY 1346283140,1750358297,1568867240
NC 1346283140,1750358297,1568867240
ND 1346283140,1750358297,1568867240
OH 1346283140,1750358297,1568867240
OK 1346283140,1750358297,1568867240
OR 1346283140,1750358297,1568867240
PA 1346283140,1750358297,1568867240
RI 1346283140,1750358297,1568867240
SC 1346283140,1750358297,1568867240
TN 1346283140,1750358297,1568867240
TX 1346283140,1750358297,1568867240
UT 1346283140,1750358297,1568867240
VT 1346283140,1750358297,1568867240
VA 1346283140,1750358297,1568867240
WA 1346283140,1750358297,1568867240
WV 1346283140,1750358297,1568867240
WI 1346283140,1750358297,1568867240
WY 1346283140,1750358297,1568867240
AR 1568867240,1346283140,1750358297
Shipping Addresses

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

CITY OF HOPE UPLAND
1100 SAN BERNARDINO RD
#1100
UPLAND, CA 91786

CITY OF HOPE CORONA
320 W 6TH STREET
ROOMS 268, 270 AND 271
CORONA, CA 92882

CITY OF HOPE ORANGE COUNTY
1000 FIVEPOINT RM 01-006
IRVINE, CA 92618

CITY OF HOPE ORANGE COUNTY
1000 FIVEPOINT
IRVINE, CA 92618

CITY OF HOPE SEACLIFF PHARMACY
2100 MAIN STREET
STE 300
HUNTINGTON BEACH, CA 92648

CITY OF HOPE SOUTH BAY PHARMACY
5215 TORRANCE BLVD #200
TORRANCE, CA 90503
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/17/202301/01/2024  01/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/17/202310/01/2023  10/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/17/202310/01/2023  10/01/2023
Contract DetailCITY OF HOPE ORANGE COUNTY1000 FIVEPOINT RM 1-006
IRVINECA9261810/17/202210/24/2022 10/24/202208/01/2023
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/17/202301/01/2024  01/01/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/17/202301/01/2024  01/01/2024
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/17/202310/01/2023  10/01/2023
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/15/202110/01/2021 02/28/202502/28/2025
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135107/15/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 401, LLC4610 NORTHGATE BLVD. STE. 130
SACRAMENTOCA95834-115407/15/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC1819 ASTON AVE STE 104
CARLSBADCA9200807/15/202210/01/2022  10/01/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/15/202207/27/2022  07/27/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/15/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729810/17/202301/01/2024  01/01/2024
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/15/202110/01/2021  10/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/17/202301/01/2024  01/01/2024
Contract DetailPREMIER INFUSION AND HEALTHCARE SERVICES19500 NORMANDIE AVE
TORRANCECA9050210/15/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/17/202310/01/2023  10/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 1010 UNIVERSITY AVENUE
SAN DIEGOCA9210307/17/202310/01/2023  10/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 8607 SANTA MONICA BOULEVARD
WEST HOLLYWOODCA9006907/17/202310/01/2023  10/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/17/202310/01/2023  10/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/17/202310/01/2023  10/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/17/202310/01/2023  10/01/2023
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAN050146-01ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE NATIONAL MEDICAL CENTE - CITY OF HOPE UPLAND1100 SAN BERNARDINO RDUPLANDCAActive
CAN050146-02ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE NATIONAL MEDICAL CENTE - CITY OF HOPE CORONA320 W 6TH STCORONACAActive
CAN050146-03ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE NATIONAL MEDICAL CENTE - City of Hope Lennar Oncology/Infusion1000 FIVEPOINTIRVINECAActive
CAN050146-04ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC OP PRE AND POST OP1000 FIVEPOINTIRVINECAActive
CAN050146-05ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ARCADIA - ARCADIA NMC RADIATION ONCOLOGY301 W. HUNTINGTON DR.ARCADIACAActive
CAN050146-06ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC INTERVENTIONAL RADIOLOGY1000 FIVEPOINTIRVINECAActive
CAN050146-07ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE UPLAND - UPLAND NMC INFUSION1100 SAN BERNARDINO RDUPLANDCAActive
CAN050146-08ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE CORONA - CORONA NMC CLINIC320 W. 6TH STCORONACAActive
CAN050146-09ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC RADIATION ONCOLOGY1000 FIVEPOINTIRVINECAActive
CAN050146-10ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE CORONA - CORONA NMC IMAGING320 W. 6TH STCORONACAActive
CAN050146-11ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC VASCULAR ACCESS DEV1000 FIVEPOINTIRVINECAActive
CAN050146-12ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE UPLAND - UPLAND NMC CLINIC1100 SAN BERNARDINO RDUPLANDCATerminated
CAN050146-13ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC MRI1000 FIVEPOINTIRVINECAActive
CAN050146-14ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC MAIN CLINIC1000 FIVEPOINTIRVINECAActive
CAN050146-15ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC INFUSION1000 FIVEPOINTIRVINECAActive
CAN050146-16ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC BREAST SCREENING & DIAG1000 FIVEPOINTIRVINECAActive
CAN050146-17ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC DIAGNOSTIC RADIOLOGY1000 FIVEPOINTIRVINECAActive
CAN050146-18ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC NUCLEAR MEDICINE1000 FIVEPOINTIRVINECAActive
CAN050146-19ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC CAT SCAN1000 FIVEPOINTIRVINECAActive
CAN050146-20ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC OP OPERATING ROOM1000 FIVEPOINTIRVINECAActive
CAN050146-21ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC ULTRASOUND1000 FIVEPOINTIRVINECAActive
CAN050146-22ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC REHAB1000 FIVEPOINTIRVINECAActive
CAN050146-23ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC CLINICAL RESEARCH INFUSION1000 FIVEPOINTIRVINECAActive
CAN050146-24ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE CORONA - CORONA NMC RADIATION320 W. 6TH STCORONACAActive
CAN050146-25ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE UPLAND - UPLAND NMC RADIATION1100 SAN BERNARDINO RDUPLANDCAActive
CAN050146-26ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE ORANGE COUNTY - OC NMC HEM/HCT DAY HOSPITAL1000 FIVEPOINTIRVINECAApproved
CAN050146-27ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE SEACLIFF - SEACLIFF NMC CLINIC2100 MAIN STREET STE 300HUNTINGTON BEACHCAApproved
CAN050146-28ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE SEACLIFF - SEACLIFF NMC INFUSION2100 MAIN STREET STE 300HUNTINGTON BEACHCAApproved
CAN050146-29ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE SOUTH BAY - SOUTH BAY NMC CLINIC5215 TORRANCE BLVD #200TORRANCECAApproved
CAN050146-30ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE SOUTH BAY - SOUTH BAY NMC RADIATION5215 TORRANCE BLVD #100TORRANCECAApproved
CAN050146-31ChildCANCITY OF HOPE NATIONAL MEDICAL CENTERCITY OF HOPE SOUTH BAY - SOUTH BAY NMC INFUSION5215 TORRANCE BLVD #200TORRANCECAApproved
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestSamara, Wafa CPO City of Hope 6268033071Samara, Wafa CPO City of Hope 626218493610/18/2024 4:16 AM
DetailsLast Recertification DateUpdateRecertification9/8/2023 12:37:00 PM8/27/2024 11:49:59 AM8/27/2024 11:49 AM
AddressesShipping AddressInsertChange Request CITY OF HOPE SOUTH BAY PHARMACY 5215 TORRANCE BLVD #200 TORRANCE, CA 905038/11/2024 9:50 PM
AddressesShipping AddressInsertChange Request CITY OF HOPE SEACLIFF PHARMACY 2100 MAIN STREET STE 300 HUNTINGTON BEACH, CA 926484/2/2024 7:41 AM
DetailsLast Recertification DateUpdateRecertification9/1/2022 12:46:36 PM9/8/2023 12:37:00 PM9/8/2023 12:37 PM
DetailsLast Recertification DateUpdateRecertification9/10/2021 1:35:30 PM9/1/2022 12:46:36 PM9/1/2022 12:46 PM
AddressesShipping AddressInsertChange Request CITY OF HOPE ORANGE COUNTY 1000 FIVEPOINT RM 01-006 IRVINE, CA 926188/3/2022 8:25 AM
AddressesShipping AddressInsertChange Request CITY OF HOPE ORANGE COUNTY 1000 FIVEPOINT IRVINE, CA 926188/3/2022 8:25 AM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AL6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AK6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AR6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request CO6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request CT6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request DE6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AR6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request AR6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request CA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request DC6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request FL6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request GA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request HI6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request ID6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request IN6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request IA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request KS6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request KY6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request LA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MD6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request ME6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NE6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MI6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MN6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MO6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MS6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request MT6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NV6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NJ6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NM6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NY6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request NC6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request ND6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request OH6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request OK6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request OR6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request PA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request RI6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request SC6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request TN6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request TX6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request UT6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request VT6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request VA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request WA6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request WV6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request WI6/15/2022 11:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15688672406/15/2022 11:08 PM
Medicaid BillingNPI: StateInsertChange Request WY6/15/2022 11:08 PM
ContactsPrimary ContactUpdateProfile Change RequestLee, Jamie Jove 340B Program Manager City of Hope 6262183236Lee, Jamie Jove Director, 340B Program City of Hope 62621832365/6/2022 10:37 PM
AddressesShipping AddressInsertChange Request CITY OF HOPE CORONA 320 W 6TH STREET ROOMS 268, 270 AND 271 CORONA, CA 9288212/14/2021 6:40 AM
DetailsLast Recertification DateUpdateRecertification9/14/2020 6:31:12 AM9/10/2021 1:35:30 PM9/10/2021 1:35 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AK6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AK6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request CO6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request CO6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request CT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request CT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request DE6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request DE6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request DC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request DC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request FL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request FL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request GA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request GA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request HI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request HI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ID6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ID6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request IA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request KS6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request KS6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request KY6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request KY6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request LA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request LA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ME6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ME6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MD6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MD6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MS6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MS6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MO6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MO6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request MT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NE6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NE6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NV6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NV6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NJ6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NJ6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NM6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NM6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NY6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NY6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request NC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ND6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request ND6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OH6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OH6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OK6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OK6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OR6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request OR6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request PA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request PA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request RI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request RI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request SC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request SC6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request TN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request TN6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request TX6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request TX6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request UT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request UT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request VT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request VT6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request VA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request VA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WA6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WV6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WV6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WI6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 13462831406/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WY6/15/2021 2:36 PM
Medicaid BillingNPI: NumberInsertChange Request 17503582976/15/2021 2:36 PM
Medicaid BillingNPI: StateInsertChange Request WY6/15/2021 2:36 PM
ContactsAuthorizing OfficialUpdateAO Change RequestHelmke, Joel SVP, Operations City of Hope 6262180301Samara, Wafa CPO City of Hope 62680330711/22/2021 4:50 PM
AddressesShipping AddressInsertChange Request CITY OF HOPE UPLAND 1100 SAN BERNARDINO RD #1100 UPLAND, CA 917861/21/2021 9:29 AM
ContactsPrimary ContactUpdateChange RequestShayani, Sepideh Director City of Hope National Medical Center 6262182510Lee, Jamie Jove 340B Program Manager City of Hope 62621832361/21/2021 9:29 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/14/2020 6:31 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/14/2020 6:31 AM
DetailsLast Recertification DateUpdateRecertification9/13/2019 6:57:34 AM9/14/2020 6:31:12 AM9/14/2020 6:31 AM
ContactsPrimary ContactUpdateChange RequestKILDOO, CARL DIRECTOR OF PHARMACY City of Hope National Med Ctr 6263018833Shayani, Sepideh Director City of Hope National Medical Center 626218251011/22/2019 9:35 AM
DetailsLast Recertification DateUpdateRecertification9/11/2018 3:21:40 PM9/13/2019 6:57:34 AM9/13/2019 6:57 AM
DetailsLast Recertification DateUpdateRecertification10/18/2017 11:08:06 AM9/11/2018 3:21:40 PM9/11/2018 3:21 PM
DetailsLast Recertification DateUpdateRecertification8/30/2016 12:00:00 AM10/18/2017 11:08:06 AM10/18/2017 11:08 AM
ContactsAuthorizing OfficialUpdate Helmke, Joel SVP, Operations 6262180301Helmke, Joel SVP, Operations City of Hope 626218030110/13/2017 6:17 PM
ContactsPrimary ContactUpdate KILDOO, CARL DIRECTOR OF PHARMACY 6263018833KILDOO, CARL DIRECTOR OF PHARMACY City of Hope National Med Ctr 626301883310/13/2017 10:15 AM
ContactsAuthorizing OfficialUpdate Sargeant, Marty Chief Operating Officer 6264717360Helmke, Joel SVP, Operations 62621803012/9/2017 4:39 PM
AddressesMain AddressInsert   1500 E. DUARTE ROAD DUARTE, CA 9101010/5/2016 3:27 PM
AddressesShipping AddressInsert  CITY OF HOPE NATIONAL MEDICAL CENTER PHARMACY 1500 E. DUARTE ROAD DUARTE, CA 9101010/5/2016 3:27 PM
ContactsPrimary ContactUpdate KILDOO, CARL DIRECTOR OF PHARMACY 6263018833KILDOO, CARL DIRECTOR OF PHARMACY 626301883310/5/2016 3:27 PM
ContactsAuthorizing OfficialUpdate DUNNE, LIZ EXECUTIVE OFFICER, MEDICAL OFFICER 6262564673-62327Sargeant, Marty Chief Operating Officer 62647173608/30/2016 12:02 PM
DetailsLast Recertification DateUpdate 9/8/2015 12:00:00 AM8/30/2016 12:00:00 AM8/30/2016 12:02 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/8/2015 4:52 PM
DetailsLast Recertification DateUpdate 9/9/2014 12:00:00 AM9/8/2015 12:00:00 AM9/8/2015 4:52 PM
DetailsLast Recertification DateUpdate 9/9/2013 12:00:00 AM9/9/2014 12:00:00 AM9/9/2014 12:04 PM
ContactsPrimary ContactUpdate ROSS, DAN VICE PRESIDENT, CHIEF PHARMACY OFFICER 6269305460KILDOO, CARL DIRECTOR OF PHARMACY 62630188337/30/2014 10:30 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/9/2013 12:00:00 AM9/9/2013 6:25 AM
ContactsPrimary ContactInsert  ROSS, DAN VICE PRESIDENT, CHIEF PHARMACY OFFICER 62693054605/2/2012 7:55 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/2/2012 7:55 AM
ContactsAuthorizing OfficialInsert  DUNNE, LIZ EXECUTIVE OFFICER, MEDICAL OFFICER 6262564673-623279/1/2010 8:27 AM
DetailsLast Recertification DateInsert   9/1/2010 8:27 AM
DetailsGrant NumberInsert   9/1/2010 8:27 AM
Details340B IDInsert  CAN050146-009/1/2010 8:27 AM
DetailsIs Authorizing Official EHB DataInsert   9/1/2010 8:27 AM
DatesLast Date That 340B Drugs PurchasedInsert   9/1/2010 8:27 AM
DetailsMedicare Provider NumberInsert  0501469/1/2010 8:27 AM
DetailsEntity NameInsert  CITY OF HOPE NATIONAL MEDICAL CENTER9/1/2010 8:27 AM
DetailsProgram CodeInsert  CAN9/1/2010 8:27 AM
DetailsEntity SubnameInsert   9/1/2010 8:27 AM
DatesParticipating Approval DateInsert  8/30/2010 12:00:00 AM9/1/2010 8:27 AM
DetailsStateInsert  Active9/1/2010 8:27 AM
DatesRegistration DateInsert  8/22/2010 12:00:00 AM9/1/2010 8:27 AM
DatesSigned By DateInsert  8/2/2010 12:00:00 AM9/1/2010 8:27 AM
DatesStart DateInsert  9/1/2010 12:00:00 AM9/1/2010 8:27 AM
TerminationsTermination CommentsInsert   9/1/2010 8:27 AM
TerminationsTermination DateInsert   9/1/2010 8:27 AM
TerminationsTermination Effective DateInsert   9/1/2010 8:27 AM
TerminationsTermination ReasonInsert   9/1/2010 8:27 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False8/22/2010 3:51 PM
Medicaid BillingMedicaid: NumberInsert  ZZT40146F8/22/2010 3:51 PM
Medicaid BillingMedicaid: StateInsert  CA8/22/2010 3:51 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True8/22/2010 3:51 PM
Medicaid BillingMedicaid: NumberInsert  PHB1851808/22/2010 3:51 PM
Medicaid BillingMedicaid: StateInsert  CA8/22/2010 3:51 PM
Medicaid BillingNPI: NumberInsert  13462831408/22/2010 3:51 PM
Medicaid BillingNPI: NumberInsert  17503582978/22/2010 3:51 PM