| Details | Last Recertification Date | Update | Recertification | 2/1/2024 8:41:16 AM | 2/13/2025 12:52:08 PM | 2/13/2025 12:52 PM |
| Addresses | Shipping Address | Delete | Recertification | Whitman-Walker Pharmacy - Max Robinson Center
2303 Martin Luther King, Jr. Ave, SE
Washington, DC 20020 | | 2/1/2024 8:41 AM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2023 9:41:22 AM | 2/1/2024 8:41:16 AM | 2/1/2024 8:41 AM |
| Contacts | Primary Contact | Update | Group Change Request | GASSER, DWAINE
Senior Director Clinical Infrastructure
Whitman-Walker Clinic
2029397650 | Krautwurst, Amie Elizabeth
Director of Grants & Programs
Whitman-Walker Health
2027456193 | 11/13/2023 3:24 PM |
| Addresses | Shipping Address | Insert | Change Request | | Whitman-Walker Clinic, Inc. dba Whitman-Walker Pharmacy
1201 Sycamore Drive SE
Washington, DC 20032 | 7/25/2023 4:44 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 2:33:04 PM | 2/14/2023 9:41:22 AM | 2/14/2023 9:41 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2021 7:59:23 PM | 2/4/2022 2:33:04 PM | 2/4/2022 2:33 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 2:46:24 PM | 2/2/2021 7:59:23 PM | 2/2/2021 7:59 PM |
| Addresses | Shipping Address | Delete | Change Request | Max Robinson Center
2303 Martin Luther King, Jr. Ave, SE
Washington, DC 20020 | | 12/28/2020 9:10 AM |
| Addresses | Shipping Address | Insert | Change Request | | Whitman-Walker Pharmacy - Max Robinson Center
2303 Martin Luther King, Jr. Ave, SE
Washington, DC 20020 | 12/28/2020 9:10 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 10:22:02 AM | 1/28/2020 2:46:24 PM | 1/28/2020 2:46 PM |
| Addresses | Billing Address | Update | Change Request | Whitman-Walker Clinic, Inc
1342 Florida Avenue, NW
Washington, DC 20009 | Whitman-Walker Clinic, Inc
1377 R Street, NW
Suite 200
Washington, DC 20009 | 10/19/2019 9:51 AM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 10:43:29 AM | 1/29/2019 10:22:02 AM | 1/29/2019 10:22 AM |
| Contacts | Authorizing Official | Update | Change Request | Blanchon, Donald
Chief Executive Officer
Whitman-Walker Health
2027974410 | Shafi, Naseema
Chief Executive Officer
Whitman-Walker Health
2027973572 | 1/18/2019 3:41 PM |
| Addresses | Shipping Address | Insert | Change Request | | Max Robinson Center
2303 Martin Luther King, Jr. Ave, SE
Washington, DC 20020 | 9/4/2018 2:54 PM |
| Details | Entity Subname | Update | Change Request | | Whitman-Walker Health | 9/4/2018 2:54 PM |
| Addresses | Billing Address | Update | Recertification | Whitman-Walker Clinic, Inc
1701 14th Street, NW
Washington, DC 20009 | Whitman-Walker Clinic, Inc
1342 Florida Avenue, NW
Washington, DC 20009 | 2/12/2018 10:43 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2017 12:00:00 AM | 2/12/2018 10:43:29 AM | 2/12/2018 10:43 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/12/2018 10:43 AM |
| Contacts | Authorizing Official | Update | | Blanchon, Donald
Chief Executive Officer
2027974410 | Blanchon, Donald
Chief Executive Officer
Whitman-Walker Health
2027974410 | 2/12/2018 9:58 AM |
| Contacts | Signed By | Update | | Blanchon, Donald
Chief Executive Officer
2027974410 | Blanchon, Donald
Chief Executive Officer
Whitman-Walker Health
2027974410 | 2/12/2018 9:58 AM |
| Contacts | Primary Contact | Update | | GASSER, DWAINE
Senior Director Clinical Infrastructure
2029397650 | GASSER, DWAINE
Senior Director Clinical Infrastructure
Whitman-Walker Clinic
2029397650 | 1/11/2018 9:49 AM |
| Contacts | Authorizing Official | Insert | | | Blanchon, Donald
Chief Executive Officer
2027974410 | 6/20/2017 10:12 AM |
| Contacts | Signed By | Insert | | | Blanchon, Donald
Chief Executive Officer
2027974410 | 6/20/2017 10:12 AM |
| Contacts | Primary Contact | Insert | | | GASSER, DWAINE
Senior Director Clinical Infrastructure
2029397650 | 4/27/2017 3:00 PM |
| Addresses | Main Address | Insert | | |
1525 14th Street Street Northwest
Washington, DC 20005 | 2/6/2017 6:06 PM |
| Details | Last Recertification Date | Update | | 2/26/2016 12:00:00 AM | 2/6/2017 12:00:00 AM | 2/6/2017 6:06 PM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 2/26/2016 12:00:00 AM | 2/27/2016 3:18 PM |
| Addresses | Billing Address | Insert | | | Whitman-Walker Clinic, Inc
1701 14th Street, NW
Washington, DC 20009 | 9/21/2015 1:25 PM |
| Addresses | Shipping Address | Insert | | | Whitman-Walker Clinic, Inc
1525 14th Street, NW
Washington, DC 20009 | 9/21/2015 1:25 PM |
| Details | Entity Subname | Update | | Elizabeth Taylor Medical Center | | 5/18/2015 2:28 PM |
| Details | Last Recertification Date | Update | | | 2/12/2015 12:00:00 AM | 2/12/2015 12:59 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 2/12/2015 12:59 PM |
| Details | 340B ID | Update | | ONLINE_REG | CHC26632-00 | 1/14/2014 10:24 AM |
| Dates | Participating Approval Date | Update | | | 1/14/2014 12:00:00 AM | 1/14/2014 10:24 AM |
| Details | State | Update | | Pending | Active | 1/14/2014 10:24 AM |
| Dates | Start Date | Update | | | 4/1/2014 12:00:00 AM | 1/14/2014 10:24 AM |
| Details | Last Recertification Date | Insert | | | | 1/13/2014 5:34 PM |
| Details | Grant Number | Insert | | | H80CS26632 | 1/13/2014 5:34 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/13/2014 5:34 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/13/2014 5:34 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/13/2014 5:34 PM |
| Details | Medicare Provider Number | Insert | | | | 1/13/2014 5:34 PM |
| Details | Entity Name | Insert | | | Whitman-Walker Clinic, Inc. | 1/13/2014 5:34 PM |
| Details | Program Code | Insert | | | CH | 1/13/2014 5:34 PM |
| Details | Entity Subname | Insert | | | Elizabeth Taylor Medical Center | 1/13/2014 5:34 PM |
| Dates | Participating Approval Date | Insert | | | | 1/13/2014 5:34 PM |
| Details | State | Insert | | | Pending | 1/13/2014 5:34 PM |
| Dates | Registration Date | Insert | | | 1/13/2014 12:00:00 AM | 1/13/2014 5:34 PM |
| Dates | Signed By Date | Insert | | | 1/13/2014 12:00:00 AM | 1/13/2014 5:34 PM |
| Dates | Start Date | Insert | | | | 1/13/2014 5:34 PM |
| Terminations | Termination Comments | Insert | | | | 1/13/2014 5:34 PM |
| Terminations | Termination Date | Insert | | | | 1/13/2014 5:34 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/13/2014 5:34 PM |
| Terminations | Termination Reason | Insert | | | | 1/13/2014 5:34 PM |