| Details | Assistance Received From Date | Update | Change Request | 5/1/2022 12:00:00 AM | 5/1/2025 12:00:00 AM | 5/1/2025 1:37 PM |
| Details | Assistance Received To Date | Update | Change Request | 4/30/2025 12:00:00 AM | 4/30/2028 12:00:00 AM | 5/1/2025 1:37 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2024 3:28:16 PM | 2/10/2025 3:46:52 PM | 2/10/2025 3:46 PM |
| Contacts | Authorizing Official | Update | New Registration | Barden, Sean
Executive VP & CFO
Mary Washington Healthcare
5407411494 | Barden, Sean Timothy
Executive VP & CFO
Mary Washington Healthcare
5407411494 | 4/10/2024 4:19 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2023 9:35:40 AM | 1/29/2024 3:28:16 PM | 1/29/2024 3:28 PM |
| Details | NOFO Number | Update | | HRSA-22-015 | | 12/16/2023 10:34 AM |
| Contacts | Primary Contact | Update | PC Change Request | Yablonski, Cathy
SVP and Chief Ambulatory Operations Officer
Mary Washington Healthcare
5407411441 | Bedwell, Jessica
Program Manager
Mary Washington Healthcare
5403743179 | 8/1/2023 9:47 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 8:58:22 AM | 1/31/2023 9:35:40 AM | 1/31/2023 9:35 AM |
| Addresses | Main Address | Update | Change Request |
1101 SAM PERRY BLVD
Suite 304
FREDERICKSBURG, VA 22401 |
1101 SAM PERRY BLVD
307
FREDERICKSBURG, VA 22401 | 10/18/2022 10:35 AM |
| Details | Assistance Received From Date | Update | Change Request | 5/1/2021 12:00:00 AM | 5/1/2022 12:00:00 AM | 10/18/2022 10:35 AM |
| Details | Assistance Received To Date | Update | Change Request | 4/30/2022 12:00:00 AM | 4/30/2025 12:00:00 AM | 10/18/2022 10:35 AM |
| Details | NOFO Number | Update | Change Request | HRSA-18-005 | HRSA-22-015 | 10/18/2022 10:35 AM |
| Contacts | Primary Contact | Update | Change Request | Fredrick, Marie
Senior VP Ambulatory & Support Services
Mary Washington Healthcare
5407411428 | Yablonski, Cathy
SVP and Chief Ambulatory Operations Officer
Mary Washington Healthcare
5407411441 | 7/19/2022 7:00 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2021 7:19:06 AM | 1/31/2022 8:58:22 AM | 1/31/2022 8:58 AM |
| Details | Assistance Received From Date | Update | Change Request | 5/1/2020 12:00:00 AM | 5/1/2021 12:00:00 AM | 8/4/2021 9:37 AM |
| Details | Assistance Received To Date | Update | Change Request | 4/30/2021 12:00:00 AM | 4/30/2022 12:00:00 AM | 8/4/2021 9:37 AM |
| Details | Assistance Received From Date | Update | Recertification | | 5/1/2020 12:00:00 AM | 2/8/2021 7:19 AM |
| Details | Assistance Received To Date | Update | Recertification | | 4/30/2021 12:00:00 AM | 2/8/2021 7:19 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 10:55:03 AM | 2/8/2021 7:19:06 AM | 2/8/2021 7:19 AM |
| Details | NOFO Number | Update | Recertification | | HRSA-18-005 | 2/8/2021 7:19 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 8:24:27 AM | 1/28/2020 10:55:03 AM | 1/28/2020 10:55 AM |
| Details | Last Recertification Date | Update | Recertification | 3/6/2018 3:41:38 PM | 1/30/2019 8:24:27 AM | 1/30/2019 8:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2017 12:00:00 AM | 3/6/2018 3:41:38 PM | 3/6/2018 3:41 PM |
| Contacts | Authorizing Official | Update | | Barden, Sean
Executive VP & CFO
5407411494 | Barden, Sean
Executive VP & CFO
Mary Washington Healthcare
5407411494 | 3/6/2018 3:37 PM |
| Contacts | Primary Contact | Update | | Fredrick, Marie
Senior VP Ambulatory & Support Services
5407411428 | Fredrick, Marie
Senior VP Ambulatory & Support Services
Mary Washington Healthcare
5407411428 | 9/25/2017 2:23 PM |
| Addresses | Main Address | Insert | | |
1101 SAM PERRY BLVD
Suite 304
FREDERICKSBURG, VA 22401 | 1/31/2017 1:35 PM |
| Contacts | Primary Contact | Update | | Robinson, Tamara
Grantor and Community Manager
5407411433 | Fredrick, Marie
Senior VP Ambulatory & Support Services
5407411428 | 1/31/2017 1:35 PM |
| Contacts | Authorizing Official | Update | | Richardson, Xavier
Exc Vice President of Corporate Development
5407411512 | Barden, Sean
Executive VP & CFO
5407411494 | 1/31/2017 1:35 PM |
| Details | Last Recertification Date | Update | | | 1/31/2017 12:00:00 AM | 1/31/2017 1:35 PM |
| Details | Entity Subname | Update | | INFECTIOUS DISEASE ASSOCIATES | WELLNESS PROGRAM | 1/31/2017 1:35 PM |
| Addresses | Billing Address | Insert | | | MARY WASHINGTON HEALTHCARE
2300 FALL HILL AVE
SUITE 418
FREDERICKBURG, VA 22401 | 11/21/2016 8:32 AM |
| Contacts | Authorizing Official | Update | | LEITE, CHERYL
EXECUTIVE PRACTICE DIRECTOR
5407412489 | Richardson, Xavier
Exc Vice President of Corporate Development
5407411512 | 10/6/2016 12:00 PM |
| Contacts | Primary Contact | Update | | HOPWOOD, SUZANNE
PROJECT COORDINATOR
5403743279 | Robinson, Tamara
Grantor and Community Manager
5407411433 | 7/19/2016 2:02 PM |
| Dates | Start Date | Update | | 10/1/2016 12:00:00 AM | 7/19/2016 12:00:00 AM | 7/19/2016 2:02 PM |
| Details | Comments Public | Insert | | | 7/19/16 Participating 01/01/2011 until terminated effective 04/01/2016, reinstated effective 7/19/16 | 7/19/2016 2:02 PM |
| Details | Last Recertification Date | Update | | 3/10/2016 12:00:00 AM | | 7/18/2016 4:16 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 4/1/2016 12:00:00 AM | | 7/18/2016 4:16 PM |
| Dates | Participating Approval Date | Update | | 12/13/2010 12:00:00 AM | 7/18/2016 12:00:00 AM | 7/18/2016 4:16 PM |
| Details | State | Update | | Terminated | Active | 7/18/2016 4:16 PM |
| Dates | Registration Date | Update | | 12/9/2010 12:00:00 AM | 7/6/2016 12:00:00 AM | 7/18/2016 4:16 PM |
| Dates | Start Date | Update | | 1/1/2011 12:00:00 AM | 10/1/2016 12:00:00 AM | 7/18/2016 4:16 PM |
| Terminations | Termination Date | Update | | 4/1/2016 12:00:00 AM | | 7/18/2016 4:16 PM |
| Terminations | Termination Effective Date | Update | | 4/1/2016 12:00:00 AM | | 7/18/2016 4:16 PM |
| Terminations | Termination Reason | Update | | Failure to recertify | | 7/18/2016 4:16 PM |
| Details | Comments Public | Insert | | | Participating [01/01/2011] until terminated effective [04/01/2016] | 7/18/2016 4:16 PM |
| Contacts | Primary Contact | Insert | | | HOPWOOD, SUZANNE
PROJECT COORDINATOR
5403743279 | 3/10/2016 10:14 AM |
| Contacts | Authorizing Official | Update | | SPRINGHORN, CHERYL
EXECUTIVE PRACTICE DIRECTOR
5407412489 | LEITE, CHERYL
EXECUTIVE PRACTICE DIRECTOR
5407412489 | 3/10/2016 10:14 AM |
| Details | Last Recertification Date | Update | | 2/23/2015 12:00:00 AM | 3/10/2016 12:00:00 AM | 3/10/2016 10:14 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 4/1/2016 12:00:00 AM | 3/10/2016 10:14 AM |
| Details | State | Update | | Active | Terminated | 3/10/2016 10:14 AM |
| Terminations | Termination Date | Update | | | 4/1/2016 12:00:00 AM | 3/10/2016 10:14 AM |
| Terminations | Termination Effective Date | Update | | | 4/1/2016 12:00:00 AM | 3/10/2016 10:14 AM |
| Terminations | Termination Reason | Update | | | Failure to recertify | 3/10/2016 10:14 AM |
| Details | Last Recertification Date | Update | | 2/24/2014 12:00:00 AM | 2/23/2015 12:00:00 AM | 2/23/2015 8:28 AM |
| Contacts | Authorizing Official | Insert | | | SPRINGHORN, CHERYL
EXECUTIVE PRACTICE DIRECTOR
5407412489 | 2/24/2014 2:50 PM |
| Details | Last Recertification Date | Update | | 1/1/2013 12:00:00 AM | 2/24/2014 12:00:00 AM | 2/24/2014 2:50 PM |
| Details | Last Recertification Date | Update | | | 1/1/2013 12:00:00 AM | 12/3/2012 4:41 PM |
| Details | Comments Public | Insert | | | 8/3/11 BILL TO ADDED | 8/3/2011 10:44 AM |
| Details | Last Recertification Date | Insert | | | | 12/13/2010 2:27 PM |
| Details | Grant Number | Insert | | | H76HA00583 | 12/13/2010 2:27 PM |
| Details | 340B ID | Insert | | | HV00583 | 12/13/2010 2:27 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/13/2010 2:27 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/13/2010 2:27 PM |
| Details | Medicare Provider Number | Insert | | | | 12/13/2010 2:27 PM |
| Details | Entity Name | Insert | | | MARY WASHINGTON HEALTHCARE | 12/13/2010 2:27 PM |
| Details | Program Code | Insert | | | HV | 12/13/2010 2:27 PM |
| Details | Entity Subname | Insert | | | INFECTIOUS DISEASE ASSOCIATES | 12/13/2010 2:27 PM |
| Dates | Participating Approval Date | Insert | | | 12/13/2010 12:00:00 AM | 12/13/2010 2:27 PM |
| Details | State | Insert | | | Active | 12/13/2010 2:27 PM |
| Dates | Registration Date | Insert | | | 12/9/2010 12:00:00 AM | 12/13/2010 2:27 PM |
| Dates | Signed By Date | Insert | | | 11/30/2010 12:00:00 AM | 12/13/2010 2:27 PM |
| Dates | Start Date | Insert | | | 1/1/2011 12:00:00 AM | 12/13/2010 2:27 PM |
| Terminations | Termination Comments | Insert | | | | 12/13/2010 2:27 PM |
| Terminations | Termination Date | Insert | | | | 12/13/2010 2:27 PM |
| Terminations | Termination Effective Date | Insert | | | | 12/13/2010 2:27 PM |
| Terminations | Termination Reason | Insert | | | | 12/13/2010 2:27 PM |