| Details | Last Recertification Date | Update | Recertification | 8/18/2023 2:14:58 PM | 8/21/2024 10:09:16 AM | 8/21/2024 10:09 AM |
| Contacts | Authorizing Official | Update | Change Request | Meisel, Michael J
VP Finance and Chief Financial Officer
MedStar St. Mary's Hospital
2025038720 | jani, purvi
CFO
Medstar
2149916090 | 7/5/2024 7:09 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2022 8:20:37 AM | 8/18/2023 2:14:58 PM | 8/18/2023 2:14 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2021 8:32:55 AM | 8/30/2022 8:20:37 AM | 8/30/2022 8:20 AM |
| Contacts | Primary Contact | Update | Change Request | Evans, Karla D.
Director of Pharmacy
MedStar Southern Maryland Hospital Center
3018775549 | Sarfo, Francisca A.
Pharmacy Director
MedStar Southern MD Hospital Ctr
3018775549 | 10/22/2021 10:11 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2020 9:52:31 AM | 8/25/2021 8:32:55 AM | 8/25/2021 8:32 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1366790693 | 8/31/2020 9:52 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | DC | 8/31/2020 9:52 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1366790693 | 8/31/2020 9:52 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MD | 8/31/2020 9:52 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1366790693 ( ) | | 8/31/2020 9:52 AM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2019 6:40:01 AM | 8/31/2020 9:52:31 AM | 8/31/2020 9:52 AM |
| Contacts | Authorizing Official | Update | Change Request | Wray, Christine R
President
MedStar Southern Maryland Hospital Center
3018774530 | Meisel, Michael J
VP Finance and Chief Financial Officer
MedStar St. Mary's Hospital
2025038720 | 7/13/2020 10:31 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2018 8:43:09 AM | 9/9/2019 6:40:01 AM | 9/9/2019 6:40 AM |
| Addresses | Shipping Address | Insert | Change Request | | EXTENCARE MEDAC MAIN
7379 Washington Blvd
Elkridge, MD 21075 | 6/14/2019 2:52 PM |
| Contacts | Authorizing Official | Update | Change Request | Jennison, Carrie J
Chief Financial Officer
MedStar St. Mary's Hospital & MedStar Southern Maryland Hospital Center
3014756003 | Wray, Christine R
President
MedStar Southern Maryland Hospital Center
3018774530 | 6/14/2019 7:32 AM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 9:33:24 PM | 9/10/2018 8:43:09 AM | 9/10/2018 8:43 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Feeley, Daniel M.
Interim Chief Financial Officer
MedStar Southern Maryland Hospital Center
3018775527 | Jennison, Carrie J
Chief Financial Officer
MedStar St. Mary's Hospital & MedStar Southern Maryland Hospital Center
3014756003 | 6/28/2018 7:55 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2016 12:00:00 AM | 11/15/2017 9:33:24 PM | 11/15/2017 9:33 PM |
| Contacts | Authorizing Official | Update | | Feeley, Daniel M.
Interim Chief Financial Officer
3018775527 | Feeley, Daniel M.
Interim Chief Financial Officer
MedStar Southern Maryland Hospital Center
3018775527 | 10/2/2017 6:45 PM |
| Contacts | Signed By | Update | | Feeley, Daniel M.
Interim Chief Financial Officer
3018775527 | Feeley, Daniel M.
Interim Chief Financial Officer
MedStar Southern Maryland Hospital Center
3018775527 | 10/2/2017 6:45 PM |
| Contacts | Primary Contact | Update | | Evans, Karla D.
Director of Pharmacy
3018775549 | Evans, Karla D.
Director of Pharmacy
MedStar Southern Maryland Hospital Center
3018775549 | 9/19/2017 4:03 PM |
| Contacts | Authorizing Official | Insert | | | Feeley, Daniel M.
Interim Chief Financial Officer
3018775527 | 1/18/2017 3:02 PM |
| Contacts | Signed By | Insert | | | Feeley, Daniel M.
Interim Chief Financial Officer
3018775527 | 1/18/2017 3:02 PM |
| Addresses | Main Address | Insert | | |
7503 SURRATTS ROAD
CLINTON, MD 20735 | 9/7/2016 7:44 PM |
| Addresses | Shipping Address | Insert | | | MedStar Southern Maryland Hospital C
7503 SURRATTS ROAD
CLINTON, MD 20735 | 9/7/2016 7:44 PM |
| Addresses | Shipping Address | Insert | | | Safecor Health, LLC
4060 Business Park Drive
Suite B
Columbus, OH 43204 | 9/7/2016 7:44 PM |
| Contacts | Primary Contact | Update | | Evans, Karla D.
Director of Pharmacy
3018775549 | Evans, Karla D.
Director of Pharmacy
3018775549 | 9/7/2016 7:44 PM |
| Medicaid Billing | Medicaid: Number | Update | | 421468000 | 421468400 | 9/7/2016 7:44 PM |
| Details | Last Recertification Date | Update | | | 8/30/2016 12:00:00 AM | 8/30/2016 10:29 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/30/2015 10:33 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 421468000 | 7/30/2015 10:33 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MD | 7/30/2015 10:33 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/30/2015 10:33 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 095595800 | 7/30/2015 10:33 AM |
| Medicaid Billing | Medicaid: State | Insert | | | DC | 7/30/2015 10:33 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1366790693 | 7/30/2015 10:33 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 3/31/2015 12:00:00 AM | | 7/30/2015 10:33 AM |
| Dates | Participating Approval Date | Update | | 3/3/2015 12:00:00 AM | 7/30/2015 12:00:00 AM | 7/30/2015 10:33 AM |
| Details | State | Update | | Terminated | Active | 7/30/2015 10:33 AM |
| Dates | Registration Date | Update | | 1/13/2015 12:00:00 AM | 7/9/2015 12:00:00 AM | 7/30/2015 10:33 AM |
| Dates | Signed By Date | Update | | 1/13/2015 12:00:00 AM | 7/9/2015 12:00:00 AM | 7/30/2015 10:33 AM |
| Dates | Start Date | Update | | 4/1/2015 12:00:00 AM | 10/1/2015 12:00:00 AM | 7/30/2015 10:33 AM |
| Terminations | Termination Comments | Update | | New entity -- unable to comply in time. Will re-register. | | 7/30/2015 10:33 AM |
| Terminations | Termination Date | Update | | 7/1/2015 12:00:00 AM | | 7/30/2015 10:33 AM |
| Terminations | Termination Effective Date | Update | | 3/31/2015 12:00:00 AM | | 7/30/2015 10:33 AM |
| Terminations | Termination Reason | Update | | Site closure | | 7/30/2015 10:33 AM |
| Details | Comments Public | Insert | | | 7/30/15 Participated starting 4/1/2015, terminated 7/1/2015 due to "site closure...New entity -- unable to comply in time. Will re-register." Reinstated based on new registration submitted in July 2015. | 7/30/2015 10:33 AM |
| Contacts | Primary Contact | Insert | | | Evans, Karla D.
Director of Pharmacy
3018775549 | 4/10/2015 4:12 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 3/31/2015 12:00:00 AM | 4/10/2015 4:12 PM |
| Details | State | Update | | Active | Terminated | 4/10/2015 4:12 PM |
| Terminations | Termination Comments | Update | | | New entity -- unable to comply in time. Will re-register. | 4/10/2015 4:12 PM |
| Terminations | Termination Date | Update | | | 7/1/2015 12:00:00 AM | 4/10/2015 4:12 PM |
| Terminations | Termination Effective Date | Update | | | 3/31/2015 12:00:00 AM | 4/10/2015 4:12 PM |
| Terminations | Termination Reason | Update | | | Site closure | 4/10/2015 4:12 PM |
| Dates | Participating Approval Date | Update | | | 3/3/2015 12:00:00 AM | 3/3/2015 1:42 PM |
| Details | State | Update | | Pending | Active | 3/3/2015 1:42 PM |
| Dates | Start Date | Update | | | 4/1/2015 12:00:00 AM | 3/3/2015 1:42 PM |
| Details | 340B ID | Update | | ONLINE_REG_49025 | DSH210062 | 2/24/2015 3:58 PM |
| Details | 340B ID | Update | | | ONLINE_REG_49025 | 1/13/2015 6:21 PM |
| Details | Last Recertification Date | Insert | | | | 1/13/2015 6:20 PM |
| Details | Grant Number | Insert | | | | 1/13/2015 6:20 PM |
| Details | 340B ID | Insert | | | | 1/13/2015 6:20 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/13/2015 6:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/13/2015 6:20 PM |
| Details | Medicare Provider Number | Insert | | | 210062 | 1/13/2015 6:20 PM |
| Details | Entity Name | Insert | | | MEDSTAR SOUTHERN MARYLAND HOSPITAL C | 1/13/2015 6:20 PM |
| Details | Program Code | Insert | | | DSH | 1/13/2015 6:20 PM |
| Details | Entity Subname | Insert | | | | 1/13/2015 6:20 PM |
| Dates | Participating Approval Date | Insert | | | | 1/13/2015 6:20 PM |
| Details | State | Insert | | | Pending | 1/13/2015 6:20 PM |
| Dates | Registration Date | Insert | | | 1/13/2015 12:00:00 AM | 1/13/2015 6:20 PM |
| Dates | Signed By Date | Insert | | | 1/13/2015 12:00:00 AM | 1/13/2015 6:20 PM |
| Dates | Start Date | Insert | | | | 1/13/2015 6:20 PM |
| Terminations | Termination Comments | Insert | | | | 1/13/2015 6:20 PM |
| Terminations | Termination Date | Insert | | | | 1/13/2015 6:20 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/13/2015 6:20 PM |
| Terminations | Termination Reason | Insert | | | | 1/13/2015 6:20 PM |