Covered Entity Details

PED103300-02 JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC. (Terminated) - information as of 6/7/2025 4:43:25 AM

Main Details

Name

JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.

Subdivision Name

JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (RADIOLOGY)

Type

Children's Hospital

Rural

340B ID

PED103300-02

Medicare Provider Number

103300

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/17/2016

Last Recertification Date

8/27/2019

Termination Date
Termination Reason

1/1/2020
Business decision by the Covered Entity

Contacts

Authorizing Official

Johns Hopkins All Children's Hospital
Thomas D Kmetz, President
(727) 767-6873

Primary Contact

Johns Hopkins All Children's Hospital, Inc.
Pamela Kravitz, Pharmacy Business Manager
(727) 767-2039

Addresses

Street Address

12220 Bruce B Downs Blvd-Room 211
Tampa, FL 33612

Billing Address

Johns Hopkins Enterprise
JH A/P Shared Service Center
PO Box #33499
Baltimore, MD 21218

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
FL	010151600
		1427114099

Shipping Addresses

Shipping Address 1

Johns Hopkins All Children's Outpatient Care, Tampa-Pharmacy
12220 Bruce B Downs Blvd.
Tampa, FL 33612

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
PED103300-01	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA	12220 BRUCE B DOWNS BLVD	TAMPA	FL	Terminated
PED103300-02	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (RADIOLOGY)	12220 Bruce B Downs Blvd-Room 211	Tampa	FL	Terminated
PED103300-03	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH TMP SPECIAL PROCS	12220 Bruce B Downs Blvd.-Room 199	Tampa	FL	Active
PED103300-04	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH TMP INFUSION	12220 BRUCE B DOWNS BLVD-Room 110	TAMPA	FL	Active
PED103300-05	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (NON-INVASIVE CARDIOLOGY)	12220 Bruce B Downs Blvd.-Room 124	Tampa	FL	Terminated
PED103300-06	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (PERINATAL CARDIOLOGY)	12220 Bruce B Downs Blvd.-Room 123	Tampa	FL	Terminated
PED103300-07	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (AUDIOLOGY)	12220 Bruce B Downs Blvd.-Room 191	Tampa	FL	Terminated
PED103300-08	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH TMP MRI	12220 Bruce B Downs Blvd.-Room 207	Tampa	FL	Active
PED103300-09	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH SPB INFUSION	601 5th Street South-Suite 300	St. Petersburg	FL	Active
PED103300-10	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH SPB PED PULMONARY	601 5th Street South-Suites 230, 280, and 780	St. Petersburg	FL	Active
PED103300-11	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (PULMONOLOGY)	12220 Bruce B Downs Blvd.-Room 153	Tampa	FL	Terminated
PED103300-12	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (HEMATOLOGY/ONCOLOGY)	12220 Bruce B Downs Blvd.-Room 125A	Tampa	FL	Terminated
PED103300-13	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH SPB PED CARDIOLOGY	601 5th Street South-Suite 260	St. Petersburg	FL	Active
PED103300-14	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (LAB)	601 5TH STREET SOUTH-Suite 204	St. Petersburg	FL	Terminated
PED103300-15	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (PEDIATRIC SURGERY OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 306	ST. PETERSBURG	FL	Terminated
PED103300-16	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (PULMONOLOGY OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 708	St. Petersburg	FL	Terminated
PED103300-17	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER ( INFECTIOUS DISEASE OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 502	ST. PETERSBURG	FL	Terminated
PED103300-18	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (RHEUMATOLOGY OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 502	St. Petersburg	FL	Terminated
PED103300-19	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (NEUROLOGY/NEUROSURGERY)	601 5TH STREET SOUTH-Suites 510-511	St. Petersburg	FL	Terminated
PED103300-20	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (BMT-BLOOD AND MARROW TRANSPLANT OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 302	ST. PETERSBURG	FL	Terminated
PED103300-21	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER ( HEMATOLOGY/ONCOLOGY OUTPATIENT CLINIC)	601 5TH STREET SOUTH-Suite 302	ST. PETERSBURG	FL	Terminated
PED103300-22	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	BFP ACH PED REHAB MED	Bayfront Medical Plaza-Johns Hopkins All Children's Rehabilitation Center	St. Petersburg	FL	Active
PED103300-23	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (SPORTS MEDICINE OUTPATIENT CLINIC)	601 5th Street South-Suite 202	St. Petersburg	FL	Terminated
PED103300-24	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (PLASTIC SURGERY OUTPATIENT CLINIC)	601 5th Street South-Suite 306	St. Petersburg	FL	Terminated
PED103300-25	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (WOUND CARE OUTPATIENT CLINIC)	601 5th Street South-Suite 306	St. Petersburg	FL	Terminated
PED103300-26	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (PEDIATRIC AND ADOLESCENT MEDICINE OUTPATIENT CLINIC)	601 5th Street South-Suite 504	St. Petersburg	FL	Terminated
PED103300-27	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH SPB PED ENDOCRIN	601 5th Street South-Suites 340	St. Petersburg	FL	Active
PED103300-28	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (CHRONIC PAIN CLINIC)	601 5th Street South-Suite 306	St. Petersburg	FL	Terminated
PED103300-29	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	ACH SPB PED NEURO DIAGNOSTICS	601 5th Street South-Suites 230 and 560	St. Petersburg	FL	Active
PED103300-30	Child	PED	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (NEUROSURGERY OUTPATIENT CLINIC)	601 5th Street South-Suite 511	St. Petersburg	FL	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Kravitz, Pamela Pharmacy Business Manager Johns Hopkins All Children's Hospital 7277672039	Kravitz, Pamela Pharmacy Business Manager Johns Hopkins All Children's Hospital, Inc. 7277672039	9/8/2021 12:14 PM
Contacts	Primary Contact	Update	Profile Change Request	Kravitz, Pamela Business Manager Johns Hopkins All Children's 7277672039	Kravitz, Pamela Pharmacy Business Manager Johns Hopkins All Children's Hospital 7277672039	3/31/2020 11:24 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Contacts	Authorizing Official	Update	AO Change Request	Alessi, Roberta VP & Chief Operating Officer Johns Hopkins All Children's 7277672868	Kmetz, Thomas D President Johns Hopkins All Children's Hospital 7277676873	12/17/2019 9:14 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/29/2019 12:00:00 AM	12/2/2019 10:39 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/2/2019 10:39 AM
Terminations	Termination Comments	Update	Termination Request		Because of limited outpatient revenue and expenses, the covered entity has chosen to terminate effective 11/29/19. This is a business decision and not necessarily a result of ineligibility. Based on this termination, all 340B drugs will stop being purchased by the covered entity effective 11/29/19.	12/2/2019 10:39 AM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	12/2/2019 10:39 AM
Terminations	Termination Effective Date	Update	Termination Request		11/29/2019 12:00:00 AM	12/2/2019 10:39 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	12/2/2019 10:39 AM
Details	Entity Name	Update	Recertification	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.	9/13/2019 3:24 PM
Addresses	Main Address	Update	Change Request	12220 Bruce B Downs Blvd-Room 173 Tampa, FL 33612	12220 Bruce B Downs Blvd-Room 211 Tampa, FL 33612	9/5/2019 10:35 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:58:23 AM	8/27/2019 2:32:58 AM	8/27/2019 2:32 AM
Details	Last Recertification Date	Update	Recertification	11/16/2017 11:32:32 AM	8/21/2018 4:58:23 AM	8/21/2018 4:58 AM
Addresses	Shipping Address	Insert	Recertification		Johns Hopkins All Children's Outpatient Care, Tampa-Pharmacy 12220 Bruce B Downs Blvd. Tampa, FL 33612	11/16/2017 11:32 AM
Addresses	Main Address	Update	Recertification	12220 BRUCE B DOWNS BLVD TAMPA, FL 33612-9201	12220 Bruce B Downs Blvd-Room 173 Tampa, FL 33612	11/16/2017 11:32 AM
Details	Last Recertification Date	Update	Recertification		11/16/2017 11:32:32 AM	11/16/2017 11:32 AM
Contacts	Authorizing Official	Update	Change Request	Alessi, Roberta VP & Chief Operating Officer 7277672868	Alessi, Roberta VP & Chief Operating Officer Johns Hopkins All Children's 7277672868	10/2/2017 7:53 AM
Contacts	Signed By	Update	Change Request	Alessi, Roberta VP & Chief Operating Officer 7277672868	Alessi, Roberta VP & Chief Operating Officer Johns Hopkins All Children's 7277672868	10/2/2017 7:53 AM
Contacts	Primary Contact	Update		Kravitz, Pamela Business Manager 7277672039	Kravitz, Pamela Business Manager Johns Hopkins All Children's 7277672039	9/29/2017 8:29 AM
Contacts	Primary Contact	Insert			Kravitz, Pamela Business Manager 7277672039	7/6/2017 9:34 AM
Contacts	Authorizing Official	Insert			Alessi, Roberta VP & Chief Operating Officer 7277672868	7/6/2017 9:34 AM
Contacts	Signed By	Insert			Alessi, Roberta VP & Chief Operating Officer 7277672868	7/6/2017 9:34 AM
Addresses	Main Address	Insert			12220 BRUCE B DOWNS BLVD TAMPA, FL 33612-9201	6/12/2017 1:57 PM
Addresses	Billing Address	Insert			Johns Hopkins Enterprise JH A/P Shared Service Center PO Box #33499 Baltimore, MD 21218	6/12/2017 1:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/12/2017 1:56 PM
Medicaid Billing	Medicaid: Number	Insert			010151600	6/12/2017 1:56 PM
Medicaid Billing	Medicaid: State	Insert			FL	6/12/2017 1:56 PM
Medicaid Billing	NPI: Number	Update		1992710503	1427114099	9/6/2016 2:18 PM
Details	Entity Name	Update		ALL CHILDRENS HOSPITAL	JOHNS HOPKINS ALL CHILDREN'S HOSPITAL	9/6/2016 2:18 PM
Details	Entity Subname	Update		ALL CHILDRENS SPECIALTY CARE OF TAM / radiology	JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA (RADIOLOGY)	9/6/2016 2:18 PM
Dates	Participating Approval Date	Update			8/17/2016 12:00:00 AM	8/17/2016 10:16 AM
Details	State	Update		Pending	Active	8/17/2016 10:16 AM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/17/2016 10:16 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71831	PED103300-02	8/15/2016 8:35 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71831	7/15/2016 8:39 AM
Medicaid Billing	NPI: Number	Insert			1992710503	7/15/2016 8:39 AM
Details	Last Recertification Date	Insert				7/15/2016 8:39 AM
Details	Grant Number	Insert				7/15/2016 8:39 AM
Details	340B ID	Insert				7/15/2016 8:39 AM
Details	Is Authorizing Official EHB Data	Insert				7/15/2016 8:39 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2016 8:39 AM
Details	Medicare Provider Number	Insert			103300	7/15/2016 8:39 AM
Details	Entity Name	Insert			ALL CHILDRENS HOSPITAL	7/15/2016 8:39 AM
Details	Program Code	Insert			PED	7/15/2016 8:39 AM
Details	Entity Subname	Insert			ALL CHILDRENS SPECIALTY CARE OF TAM / radiology	7/15/2016 8:39 AM
Dates	Participating Approval Date	Insert				7/15/2016 8:39 AM
Details	State	Insert			Pending	7/15/2016 8:39 AM
Dates	Registration Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 8:39 AM
Dates	Signed By Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 8:39 AM
Dates	Start Date	Insert				7/15/2016 8:39 AM
Terminations	Termination Comments	Insert				7/15/2016 8:39 AM
Terminations	Termination Date	Insert				7/15/2016 8:39 AM
Terminations	Termination Effective Date	Insert				7/15/2016 8:39 AM
Terminations	Termination Reason	Insert				7/15/2016 8:39 AM