Covered Entity Details

PED093300-08 Northern Virginia Heme-Onc Regional Outpatient Center (Terminated) - information as of 6/6/2025 4:24:45 AM

Main Details

Name

Northern Virginia Heme-Onc Regional Outpatient Center

Subdivision Name

Northern Virginia Heme-Onc Regional Outpatient Center

Type

Children's Hospital

Rural

340B ID

PED093300-08

Medicare Provider Number

093300

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

8/31/2012

Participating Start Date

10/1/2012

Participating Approval Date

9/14/2012

Last Recertification Date

8/17/2015

Termination Date
Termination Reason

10/1/2015
Site closure

Contacts

Authorizing Official

Children's National Medical Center
Kathleen Gorman, EVP, Patient Care services & Chief Operating Officer
(202) 476-2939

Primary Contact

Ursula Tachie-Menson, Chief of Pharmacy
(202) 476-2697

Addresses

Street Address

6565 Arlington Boulevard
Suite 200
Falls Church, VA 22042

Billing Address
Same as Street Address

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
DC	027980100
MD	950025100
VA	09-0016-8
		1912939703

Shipping Addresses

Shipping Address 1

HEM/ONC Clinic
6565 Arlington Boulevard
Suite 200
Falls Church, VA 22042

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
PED093300-02	Child	PED	Children's National Medical Center	Children's National Columbia Heights	3336 14th Street NW	Washington	DC	Active
PED093300-03	Child	PED	Children's National Medical Center	Goldberg - Comp Clinic	2220 11th St NW	Washington	DC	Terminated
PED093300-04	Child	PED	Children's Hospital	Goldberg- Good Hope Road	2501 Good Hope Road SE	Washington	DC	Terminated
PED093300-05	Child	PED	Children's Hospital	Goldberg- MLK	3029 Martin Luther King, Jr. Avenue, SE	Washington	DC	Terminated
PED093300-06	Child	PED	Children's National Medical Center	Goldberg-Mobile Health	1901 Mississippi Avenue SE	Washington	DC	Active
PED093300-07	Child	PED	Children's National Medical Center	Goldberg- THEARC	1801 Mississippi Avenue SE	Washington	DC	Active
PED093300-08	Child	PED	Northern Virginia Heme-Onc Regional Outpatient Center	Northern Virginia Heme-Onc Regional Outpatient Center	6565 Arlington Boulevard	Falls Church	VA	Terminated
PED093300-09	Child	PED	Children's National Medical Center	Annapolis Regional Outpatient Center	1730 West St, 1st Floor	Annapolis	MD	Active
PED093300-10	Child	PED	Children's National Medical Center	Northern Virginia Regional Outpatient Center	3023 Hamaker Court	Fairfax	VA	Active
PED093300-11	Child	PED	Children's Hospital	ROC- Frederick	5910 Frederick Crossing Lane	Frederick	MD	Terminated
PED093300-12	Child	PED	Children's National Medical Center	Children's National Prince Georges	2900 North Campus Way	Lanham	MD	Active
PED093300-13	Child	PED	Children's National Medical Center	ROC- Montgomery County Neuropsych	15245 Shady Grove Rd	Rockville	MD	Active
PED093300-14	Child	PED	Children's National Medical Center	Montgomery County Regional	9850 Key West Avenue	Rockville	MD	Active
PED093300-15	Child	PED	Children's National Medical Center	Friendship Heights Outpatient Center	5028 Wisconsin Ave, NW	Washington	DC	Active
PED093300-16	Child	PED	Children's National Medical Center	Children's National Prince Georges	2900 North Campus Way	Lanham	MD	Active
PED093300-17	Child	PED	Children's National Medical Center	Children's NMC-Emergency Department at United Medical Center	1310 Southern Ave SE	Washington	DC	Active
PED093300-18	Child	PED	Children's National Medical Center	Montgomery County Regional / Dermatology	9850 Key West Avenue	Rockville	MD	Active
PED093300-19	Child	PED	Children's National Medical Center	Montgomery County Regional / Pulmonary	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-20	Child	PED	Children's National Medical Center	Montgomery County Regional / Allergy and Immunology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-21	Child	PED	Children's National Medical Center	Montgomery County Regional / Cardiology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-22	Child	PED	Children's National Medical Center	Montgomery County Regional / Endocrinology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-23	Child	PED	Children's National Medical Center	Montgomery County Regional / Genetics/Developmental Peds	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-24	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Hematology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-25	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Oncology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-26	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Rheumatology	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-27	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Neurosurgery	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-28	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / EEG	9850 Key West Avenue 4th Floor	Rockville	MD	Active
PED093300-29	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Neurology	9850 Key West Avenue 3rd Floor	Rockville	MD	Active
PED093300-30	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / General Surgery	9850 Key West Avenue	Rockville	MD	Active
PED093300-31	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Pain Medicine	9850 Key West Avenue 3rd Floor	Rockville	MD	Active
PED093300-32	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Urology	9850 Key West Avenue 3rd Floor	Rockville	MD	Active
PED093300-33	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Laser	9850 Key West Avenue 2nd Floor	Rockville	MD	Active
PED093300-34	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Occupational Therapy	9850 Key West Avenue	Rockville	MD	Active
PED093300-35	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Physical Therapy	9850 Key West Avenue	Rockville	MD	Active
PED093300-36	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Nutrition	9850 Key West Avenue	Rockville	MD	Active
PED093300-37	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Audiology	9850 Key West Avenue	Rockville	MD	Active
PED093300-38	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Speech	9850 Key West Avenue	Rockville	MD	Active
PED093300-39	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Plastic Surgery	9850 Key West Avenue 2nd Floor	Rockville	MD	Active
PED093300-40	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Physical Medicine	9850 Key West Avenue	Rockville	MD	Active
PED093300-41	Child	PED	Children's National Medical Center	Montgomery County Regional / Orthopedics	9850 Key West Avenue	Rockville	MD	Active
PED093300-42	Child	PED	Children's National Medical Center	Montgomery County Regional / Gastroenterology	9850 Key West Avenue	Rockville	MD	Active
PED093300-43	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Otolaryngology	9850 KEY WEST AVE	ROCKVILLE	MD	Active
PED093300-44	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Nephrology	9850 Key West Avenue	Rockville	MD	Active
PED093300-45	Child	PED	Children's National Medical Center	Childrens National Imaging	9850 Key West Ave	Rockville	MD	Active
PED093300-46	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Surgical Gynecology	9850 Key West Ave	Rockville	MD	Active
PED093300-47	Child	PED	Children's National Medical Center	Montgomery County Regional Outpatient Center / Ophthalmology	9850 KEY WEST AVE	ROCKVILLE	MD	Active
PED093300-48	Child	PED	Children's National Medical Center	Goldberg-Anacostia - Anacostia	2101 Martin Luther King, Jr. Ave SE	Washington	DC	Active
PED093300-49	Child	PED	Children's National Medical Center	Howard County Outpatient Center - Howard County Outpatient Center	7625 Maple Lawn Blvd, Suite 230	Fulton	MD	Active
PED093300-50	Child	PED	Children's National Medical Center	Children's National Shepherd Park - Genetics	7125 13th Place NW	Washington	DC	Active
PED093300-51	Child	PED	Children's National Medical Center	Children's National Shepherd Park - Primary Care and Rare Disease Institute	7125 13th Place NW	Washington	DC	Active
PED093300-52	Child	PED	Children's National Medical Center	CHILDREN'S HOSPITAL - Pulmonary Medicine Rockville	9711 MEDICAL CENTER DR	ROCKVILLE	MD	Active
PED093300-53	Child	PED	Children's National Medical Center	CHILDREN'S HOSPITAL - Fight For Children Sports Medicine Center	1 INVENTA PL	SILVER SPRING	MD	Active
PED093300-54	Child	PED	Children's National Medical Center	CHILDRENS HOSPITAL - Montgomery County Ambulatory Surgery Center	9850 KEY WEST AVE	ROCKVILLE	MD	Active
PED093300-55	Child	PED	Children's National Medical Center	Shaw Metro - Primary Care	641 S Street NW	Washington	DC	Active
PED093300-56	Child	PED	Children's National Medical Center	CHILDREN'S HOSPITAL - Takoma Theatre	6833 4TH ST NW	WASHINGTON	DC	Active

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Gorman, Kathleen EVP, Patient Care services & Chief Operating Officer 2024762939	Gorman, Kathleen EVP, Patient Care services & Chief Operating Officer Children's National Medical Center 2024762939	11/30/2017 9:39 AM
Contacts	Authorizing Official	Insert		Gorman, Kathleen EVP, Patient Care services & Chief Operating Officer 2024762939	8/10/2017 11:03 PM
Contacts	Signed By	Insert		Newman, Kurt President & CEO 2024763761	7/25/2017 2:55 PM
Contacts	Primary Contact	Update	Tachie-Menson, Ursula Acting Chief of Pharmacy 2024762697	Tachie-Menson, Ursula Chief of Pharmacy 2024762697	3/27/2017 10:07 AM
Details	Last Recertification Date	Update	9/4/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 1:54 PM
Dates	Last Date That 340B Drugs Purchased	Update		3/20/2015 12:00:00 AM	8/17/2015 1:54 PM
Details	State	Update	Active	Terminated	8/17/2015 1:54 PM
Terminations	Termination Comments	Update		Site is no longer a Childrens National clinic and is a joint venture with Inova as Pediatric Specialists of Virginia	8/17/2015 1:54 PM
Terminations	Termination Date	Update		10/1/2015 12:00:00 AM	8/17/2015 1:54 PM
Terminations	Termination Effective Date	Update		4/6/2015 12:00:00 AM	8/17/2015 1:54 PM
Terminations	Termination Reason	Update		Site closure	8/17/2015 1:54 PM
Addresses	Main Address	Update	6565 Arlington Boulevard Suite 200 Fairfax, VA 22042	6565 Arlington Boulevard Suite 200 Falls Church, VA 22042	8/17/2015 1:53 PM
Addresses	Main Address	Insert		6565 Arlington Boulevard Suite 200 Fairfax, VA 22042	8/17/2015 1:53 PM
Details	Last Recertification Date	Update	9/10/2013 12:00:00 AM	9/4/2014 12:00:00 AM	9/4/2014 10:22 AM
Contacts	Primary Contact	Insert		Tachie-Menson, Ursula Acting Chief of Pharmacy 2024762697	7/23/2014 3:02 PM
Details	Last Recertification Date	Update		9/10/2013 12:00:00 AM	9/10/2013 12:12 PM
Addresses	Shipping Address	Insert		HEM/ONC Clinic 6565 Arlington Boulevard Suite 200 Falls Church, VA 22042	11/5/2012 6:48 AM
Details	Entity Name	Update	Children's Hospital	Northern Virginia Heme-Onc Regional Outpatient Center	10/10/2012 9:34 AM
Details	Entity Subname	Update	HEM/ONC Clinic	Northern Virginia Heme-Onc Regional Outpatient Center	10/10/2012 9:34 AM
Details	340B ID	Update	IS-DR-PED093300-08	PED093300-08	9/14/2012 1:11 PM
Dates	Participating Approval Date	Update		9/14/2012 12:00:00 AM	9/14/2012 1:11 PM
Details	State	Update	Pending	Active	9/14/2012 1:11 PM
Dates	Start Date	Update		10/1/2012 12:00:00 AM	9/14/2012 1:11 PM
Details	340B ID	Update	OUTPATIENT_ONLINE_REG	IS-DR-PED093300-08	9/12/2012 3:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: Number	Insert		027980100	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: State	Insert		DC	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: Number	Insert		950025100	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: State	Insert		MD	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: Number	Insert		09-0016-8	8/31/2012 2:03 PM
Medicaid Billing	Medicaid: State	Insert		VA	8/31/2012 2:03 PM
Medicaid Billing	NPI: Number	Insert		1912939703	8/31/2012 2:03 PM
Details	Last Recertification Date	Insert			8/31/2012 2:03 PM
Details	Grant Number	Insert			8/31/2012 2:03 PM
Details	340B ID	Insert		OUTPATIENT_ONLINE_REG	8/31/2012 2:03 PM
Details	Is Authorizing Official EHB Data	Insert			8/31/2012 2:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert			8/31/2012 2:03 PM
Details	Medicare Provider Number	Insert		093300	8/31/2012 2:03 PM
Details	Entity Name	Insert		Children's Hospital	8/31/2012 2:03 PM
Details	Program Code	Insert		PED	8/31/2012 2:03 PM
Details	Entity Subname	Insert		HEM/ONC Clinic	8/31/2012 2:03 PM
Dates	Participating Approval Date	Insert			8/31/2012 2:03 PM
Details	State	Insert		Pending	8/31/2012 2:03 PM
Dates	Registration Date	Insert		8/31/2012 12:00:00 AM	8/31/2012 2:03 PM
Dates	Signed By Date	Insert		8/31/2012 12:00:00 AM	8/31/2012 2:03 PM
Dates	Start Date	Insert			8/31/2012 2:03 PM
Terminations	Termination Comments	Insert			8/31/2012 2:03 PM
Terminations	Termination Date	Insert			8/31/2012 2:03 PM
Terminations	Termination Effective Date	Insert			8/31/2012 2:03 PM
Terminations	Termination Reason	Insert			8/31/2012 2:03 PM