Covered Entity Details

DSH210009JD JOHNS HOPKINS HOSPITAL (Active) - information as of 6/22/2025 11:01:16 PM

Main Details

Name

JOHNS HOPKINS HOSPITAL

Subdivision Name

JHH VRGH ONC INFusion - oncology infusion viragh

Type

Disproportionate Share Hospital

Rural

340B ID

DSH210009JD

Medicare Provider Number

210009

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/26/2018

Participating Start Date

4/1/2018

Participating Approval Date

2/8/2018

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

The Johns Hopkins Hospital
Katina Williams, VP CFO
(410) 502-5388

Primary Contact

Johns Hopkins
David Curtis Stimler, Assistant Director, Purchasing and Contracting for Pharmacy
(410) 502-3454

Addresses

Street Address

201 North Broadway
Baltimore, MD 21231

Billing Address

Johns Hopkins Hospital
Corporate Accts Payable
PO BOX # 33499
Baltimore, MD 21218-0404

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
MD	000065500	1578597993

Shipping Addresses

Same as Street Address

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
DSH210009AA	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO-Hydrocephalus	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AB	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO-Peripheral Nerve	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AC	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO-Stroke Prevention	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AD	Child	DSH	JOHNS HOPKINS HOSPITAL	Lumbar Puncture	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AE	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurofibromatosis	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AF	Child	DSH	JOHNS HOPKINS HOSPITAL	Psychiatric Outpatient	911 N. Broadway	Baltimore	MD	Active
DSH210009AG	Child	DSH	JOHNS HOPKINS HOSPITAL	Substance Abuse- Alcoholism	911 N. Broadway	Baltimore	MD	Terminated
DSH210009AH	Child	DSH	JOHNS HOPKINS HOSPITAL	HATS	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Catheter	600 North Wolfe Street	Baltimore	MD	Terminated
DSH210009AK	Child	DSH	JOHNS HOPKINS HOSPITAL	Express Testing-Lab	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AL	Child	DSH	JOHNS HOPKINS HOSPITAL	Laboratory Services	601 North Caroline Street	Baltimore	MD	Terminated
DSH210009AM	Child	DSH	JOHNS HOPKINS HOSPITAL	Vaccine Administration	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AN	Child	DSH	JOHNS HOPKINS HOSPITAL	Pain Treatment	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AP	Child	DSH	JOHNS HOPKINS HOSPITAL	Pain Treatment - Anesthesia	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Dermatology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AR	Child	DSH	JOHNS HOPKINS HOSPITAL	Derm PLC	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AS	Child	DSH	JOHNS HOPKINS HOSPITAL	Derm Excision	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AT	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac (Congested) Heart Failure	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AU	Child	DSH	JOHNS HOPKINS HOSPITAL	Hematology (LAB) (7th floor)	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AV	Child	DSH	JOHNS HOPKINS HOSPITAL	Internal Medicine - Specialty	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AW	Child	DSH	JOHNS HOPKINS HOSPITAL	IV Infusion	1800 Orleans St	Baltimore	MD	Terminated
DSH210009AX	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac Consult (Prevention)	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009AY	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009AZ	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac - Coumadin Anti-Coag	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BA	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiology -Adult	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BB	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac ED Chest Pain	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BC	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiology - Heart Station	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BD	Child	DSH	JOHNS HOPKINS HOSPITAL	Electro Physiology Device Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BE	Child	DSH	JOHNS HOPKINS HOSPITAL	Medicine/Infectious Disease-Moore-P	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BF	Child	DSH	JOHNS HOPKINS HOSPITAL	Infect. Diseases-Prigram for Alcohol & other Drug Depend	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BG	Child	DSH	JOHNS HOPKINS HOSPITAL	Medicine/Infectious- Psychiatry	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BH	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious Diseases -Buprenorphine	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious Diseases- Dermatology	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BK	Child	DSH	JOHNS HOPKINS HOSPITAL	Gynecology At Moore	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BL	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious- Hepatitis C	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009BM	Child	DSH	JOHNS HOPKINS HOSPITAL	Nephrology	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BN	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious-Neurology at Moore	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BP	Child	DSH	JOHNS HOPKINS HOSPITAL	Medicine/General - Nutrition at Moore	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious Diseases - Treatment Ctr	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BR	Child	DSH	JOHNS HOPKINS HOSPITAL	Medicine/Endocrinology - Lipodystrophy	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BS	Child	DSH	JOHNS HOPKINS HOSPITAL	Clinics - AIDS	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BT	Child	DSH	JOHNS HOPKINS HOSPITAL	Sickle Cell Infusion	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BU	Child	DSH	JOHNS HOPKINS HOSPITAL	Radiology Diagnostic, Mammography Services	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009BV	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Cardiology	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BW	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Echo	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BX	Child	DSH	JOHNS HOPKINS HOSPITAL	Peds psych	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009BY	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Primary Care 501	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009BZ	Child	DSH	JOHNS HOPKINS HOSPITAL	Comprhensive Child Care Ctr	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CA	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Intensive Primary Care	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CB	Child	DSH	JOHNS HOPKINS HOSPITAL	Genetic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009CC	Child	DSH	JOHNS HOPKINS HOSPITAL	Allergy	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CD	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Surgery	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009CE	Child	DSH	JOHNS HOPKINS HOSPITAL	Endocrine	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CF	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Lipid	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CG	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Rheumatology	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CH	Child	DSH	JOHNS HOPKINS HOSPITAL	Gastroenterology	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Renal	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CK	Child	DSH	JOHNS HOPKINS HOSPITAL	Cystic Fibrosis	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CL	Child	DSH	JOHNS HOPKINS HOSPITAL	Hematology	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009CM	Child	DSH	JOHNS HOPKINS HOSPITAL	Diagnostic Referral	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CN	Child	DSH	JOHNS HOPKINS HOSPITAL	Pulmonary	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CP	Child	DSH	JOHNS HOPKINS HOSPITAL	Immunology	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Sub Vascular	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CR	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Derm	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CS	Child	DSH	JOHNS HOPKINS HOSPITAL	Infectious Disease	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CT	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Infusion	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009CU	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Oncology	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009CV	Child	DSH	JOHNS HOPKINS HOSPITAL	Child Psychiatry Day	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009CW	Child	DSH	JOHNS HOPKINS HOSPITAL	Broadway Primary Care	911 N. Broadway	Baltimore	MD	Terminated
DSH210009CX	Child	DSH	JOHNS HOPKINS HOSPITAL	Children Mental Health	401 N. Caroline St.	Baltimore	MD	Active
DSH210009CY	Child	DSH	JOHNS HOPKINS HOSPITAL	Community Psychiatry	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009CZ	Child	DSH	JOHNS HOPKINS HOSPITAL	Phipps Outpatient Clinic	600 North Wolfe Street	Baltimore	MD	Terminated
DSH210009DA	Child	DSH	JOHNS HOPKINS HOSPITAL	Psy Intensive Outpatient	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009DB	Child	DSH	JOHNS HOPKINS HOSPITAL	Substance Abuse- PAODD Extended	912 N. Broadway	Baltimore	MD	Terminated
DSH210009DC	Child	DSH	JOHNS HOPKINS HOSPITAL	OPD PSYCH	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009DD	Child	DSH	JOHNS HOPKINS HOSPITAL	Phipps Pain program	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009DE	Child	DSH	JOHNS HOPKINS HOSPITAL	Schizophrenia Day Hosp	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009DF	Child	DSH	JOHNS HOPKINS HOSPITAL	Eating Disorders	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009DG	Child	DSH	JOHNS HOPKINS HOSPITAL	Affective Day Hospital	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009DH	Child	DSH	JOHNS HOPKINS HOSPITAL	Psych: Geriatric Day Hospital	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009DJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Cortical Function Lab	600 North Wolfe Street	Baltimore	MD	Terminated
DSH210009DK	Child	DSH	JOHNS HOPKINS HOSPITAL	CWC Extended	911 N. Broadway	Baltimore	MD	Active
DSH210009DL	Child	DSH	JOHNS HOPKINS HOSPITAL	Family Planning	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DM	Child	DSH	JOHNS HOPKINS HOSPITAL	Gynecology General Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DN	Child	DSH	JOHNS HOPKINS HOSPITAL	GYN Colposcopy	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DP	Child	DSH	JOHNS HOPKINS HOSPITAL	GYN/OB Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DQ	Child	DSH	JOHNS HOPKINS HOSPITAL	GYN/OB High-Risk Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DR	Child	DSH	JOHNS HOPKINS HOSPITAL	OB Nurse History	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DS	Child	DSH	JOHNS HOPKINS HOSPITAL	Gynecology Oncology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DT	Child	DSH	JOHNS HOPKINS HOSPITAL	GYN/OB General Gynecology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DU	Child	DSH	JOHNS HOPKINS HOSPITAL	GYN Fertility Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009DV	Child	DSH	JOHNS HOPKINS HOSPITAL	Prenatal Genetic Counseling	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009DW	Child	DSH	JOHNS HOPKINS HOSPITAL	Obstetrics	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009DX	Child	DSH	JOHNS HOPKINS HOSPITAL	Ophthalmology Same Day	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009DY	Child	DSH	JOHNS HOPKINS HOSPITAL	Ophthalmological - General	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009DZ	Child	DSH	JOHNS HOPKINS HOSPITAL	OPHTH ORX	400 N. Broadway	Baltimore	MD	Active
DSH210009E	Child	DSH	JOHNS HOPKINS HOSPITAL	TYSABRI Infusion Center	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EA	Child	DSH	JOHNS HOPKINS HOSPITAL	Opthalmology -Low Vision Center	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009EB	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Vascular CVDL	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EC	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Endocrine	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009ED	Child	DSH	JOHNS HOPKINS HOSPITAL	General Surgery Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EF	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Advanced Practice	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EG	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery General	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EH	Child	DSH	JOHNS HOPKINS HOSPITAL	Renal/Liver Transplant	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Compr Transplant Center	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EK	Child	DSH	JOHNS HOPKINS HOSPITAL	Cochlear Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EL	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Suite	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EM	Child	DSH	JOHNS HOPKINS HOSPITAL	AVON Breast Center	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EN	Child	DSH	JOHNS HOPKINS HOSPITAL	Melanoma/Breast	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EP	Child	DSH	JOHNS HOPKINS HOSPITAL	Breast Center/Plastics	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Vascular Access	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009ER	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Plastic Surgery	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009ES	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgical Plastic OR	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009ET	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Plastic Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EU	Child	DSH	JOHNS HOPKINS HOSPITAL	Surgery Melanoma Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EV	Child	DSH	JOHNS HOPKINS HOSPITAL	Orthopedic Fracture	601 N. Caroline street	Baltimore	MD	Terminated
DSH210009EW	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho-Pediatric Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EX	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho-Pediatric Private	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EY	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho-Pediatric Scoliosis	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009EZ	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho-Adult Private	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009F	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO-Muscular Dystrophy	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FA	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Ortho Spine	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FB	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho-Hand	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FC	Child	DSH	JOHNS HOPKINS HOSPITAL	Ortho	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FD	Child	DSH	JOHNS HOPKINS HOSPITAL	Orthopaedics Podiatry Clinic	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FE	Child	DSH	JOHNS HOPKINS HOSPITAL	Urology-Adult-surgical (4th floor)	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FF	Child	DSH	JOHNS HOPKINS HOSPITAL	Ryan White 1 Stop	911 N. Broadway	Baltimore	MD	Terminated
DSH210009FG	Child	DSH	JOHNS HOPKINS HOSPITAL	Ryan White 2 Stop	911 N. Broadway	Baltimore	MD	Terminated
DSH210009FH	Child	DSH	JOHNS HOPKINS HOSPITAL	Medical Oncology	401 N. Broadway	Baltimore	MD	Terminated
DSH210009FJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Medical First Step	600 North Wolfe Street	Baltimore	MD	Terminated
DSH210009FK	Child	DSH	JOHNS HOPKINS HOSPITAL	IPOP Ambulatory	401 N. Broadway	Baltimore	MD	Terminated
DSH210009FL	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro INT E&M	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009FM	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Voiding Dysfunction	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009FN	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Private Urology	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009FP	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Urology	200 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009FQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Resident Child Life	600 N. Wolfe Street	Baltimore	MD	Terminated
DSH210009FR	Child	DSH	JOHNS HOPKINS HOSPITAL	Endocrine Surgery	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FS	Child	DSH	JOHNS HOPKINS HOSPITAL	Plastic Surgery	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FT	Child	DSH	JOHNS HOPKINS HOSPITAL	Ear, Nose & Throat	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FU	Child	DSH	JOHNS HOPKINS HOSPITAL	PEDS Otolaryngology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FV	Child	DSH	JOHNS HOPKINS HOSPITAL	Orthopedic Surg	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009FW	Child	DSH	JOHNS HOPKINS HOSPITAL	Radiation Oncology	401 N. Broadway	Baltimore	MD	Terminated
DSH210009FX	Child	DSH	JOHNS HOPKINS HOSPITAL	Weinberg CT/Xray	401 N. Broadway	Baltimore	MD	Terminated
DSH210009FY	Child	DSH	JOHNS HOPKINS HOSPITAL	Periop	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009FZ	Child	DSH	JOHNS HOPKINS HOSPITAL	GOR Same Day	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009G	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Epilepsy	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009GB	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Emergency Room	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009GC	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Emergency Room	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009GD	Child	DSH	JOHNS HOPKINS HOSPITAL	Endoscopy	1800 Orleans Street	Baltimore	MD	Terminated
DSH210009GE	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Nutrition	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009GF	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Nutrition	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009GG	Child	DSH	JOHNS HOPKINS HOSPITAL	Pulmonary Function Test Lab	601 North Caroline Street	Baltimore	MD	Terminated
DSH210009GH	Child	DSH	JOHNS HOPKINS HOSPITAL	Derm Surgery	601 N. Caroline St	Baltimore	MD	Terminated
DSH210009GJ	Child	DSH	JOHNS HOPKINS HOSPITAL	JHOC OR	601 N Caroline St	Baltimore	MD	Terminated
DSH210009GK	Child	DSH	JOHNS HOPKINS HOSPITAL	Fetal Assessment	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GL	Child	DSH	JOHNS HOPKINS HOSPITAL	Vascular Lab	601 N Caroline St	Baltimore	MD	Terminated
DSH210009GM	Child	DSH	JOHNS HOPKINS HOSPITAL	Interventional Radiology	601 N Caroline St	Baltimore	MD	Terminated
DSH210009GN	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac Cath Int Rad	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009GP	Child	DSH	JOHNS HOPKINS HOSPITAL	Cardiac CT Scan	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro IR cvil	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GR	Child	DSH	JOHNS HOPKINS HOSPITAL	Pathology	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GS	Child	DSH	JOHNS HOPKINS HOSPITAL	Purchase Service Lab	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GT	Child	DSH	JOHNS HOPKINS HOSPITAL	Ped Pulmonary Function	200 N Wolfe St	Baltimore	MD	Terminated
DSH210009GU	Child	DSH	JOHNS HOPKINS HOSPITAL	Occ Therapy	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GV	Child	DSH	JOHNS HOPKINS HOSPITAL	Psychiatric OT	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GW	Child	DSH	JOHNS HOPKINS HOSPITAL	Physical Therapy	601 N Caroline St	Baltimore	MD	Terminated
DSH210009GX	Child	DSH	JOHNS HOPKINS HOSPITAL	Speech therapy	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GY	Child	DSH	JOHNS HOPKINS HOSPITAL	Echocardiography	1800 Orleans St	Baltimore	MD	Terminated
DSH210009GZ	Child	DSH	JOHNS HOPKINS HOSPITAL	Sleep Lab	601 N Caroline St	Baltimore	MD	Terminated
DSH210009H	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurosurgery	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009HA	Child	DSH	JOHNS HOPKINS HOSPITAL	Perinatal ultrasound	1800 Orleans St	Baltimore	MD	Terminated
DSH210009HB	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurosciences OPD Clinic	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HC	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurosciences OPD	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HD	Child	DSH	JOHNS HOPKINS HOSPITAL	Photopheresis	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HE	Child	DSH	JOHNS HOPKINS HOSPITAL	Institute of Genetic Medicine	1800 Orleans St.	Baltimore	MD	Terminated
DSH210009HF	Child	DSH	JOHNS HOPKINS HOSPITAL	Heart Center Clinic	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HG	Child	DSH	JOHNS HOPKINS HOSPITAL	Heart Failure Clinic	1800 Orleans St	Baltimore	MD	Terminated
DSH210009HH	Child	DSH	JOHNS HOPKINS HOSPITAL	Medicine Diabetes Center	601 N Caroline St.	Baltimore	MD	Terminated
DSH210009HJ	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Medicine Gastroenterology	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HK	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Medicine Hematology	601 N. Caroline St	BALTIMORE	MD	Terminated
DSH210009HL	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Medicine General Internal Med	601 N. Caroline St	Baltimore	MD	Terminated
DSH210009HM	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Med Nephrology	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HN	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Medicine Pulmonology	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HP	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Med Rheumatology	601 N Caroline St	BALTIMORE	MD	Terminated
DSH210009HQ	Child	DSH	JOHNS HOPKINS HOSPITAL	Executive Health Program	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HR	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Medicine Endocrinology	601 N Caroline St.	Baltimore	MD	Terminated
DSH210009HS	Child	DSH	JOHNS HOPKINS HOSPITAL	Peds Specialty clinics 502	200 N Wolfe St	Baltimore	MD	Terminated
DSH210009HT	Child	DSH	JOHNS HOPKINS HOSPITAL	Cortical FN O/P Clinic	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HU	Child	DSH	JOHNS HOPKINS HOSPITAL	L&D	1800 Orleans St	Baltimore	MD	Terminated
DSH210009HV	Child	DSH	JOHNS HOPKINS HOSPITAL	Urology Clinic	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HW	Child	DSH	JOHNS HOPKINS HOSPITAL	Oto audiology	601 N Carline St	Baltimore	MD	Terminated
DSH210009HX	Child	DSH	JOHNS HOPKINS HOSPITAL	OHNS ENG clinic	601 N Caroline St	Baltimore	MD	Terminated
DSH210009HY	Child	DSH	JOHNS HOPKINS HOSPITAL	Weinberg ORX	401 N. Broadway	Baltimore	MD	Terminated
DSH210009HZ	Child	DSH	JOHNS HOPKINS HOSPITAL	PreOP eval	601 N Caroline St	Baltimore	MD	Terminated
DSH210009J	Child	DSH	JOHNS HOPKINS HOSPITAL	General Neurosurgery	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009JA	Child	DSH	JOHNS HOPKINS HOSPITAL	Radiology IRC	601 N Caroline St	Baltimore	MD	Terminated
DSH210009JB	Child	DSH	JOHNS HOPKINS HOSPITAL	radioisotope nuc med	601 N Caroline St	Baltimore	MD	Terminated
DSH210009JC	Child	DSH	JOHNS HOPKINS HOSPITAL	Nuclear Ned OPD	601 N Caroline St	Baltimore	MD	Terminated
DSH210009JD	Child	DSH	JOHNS HOPKINS HOSPITAL	JHH VRGH ONC INFusion - oncology infusion viragh	201 North Broadway	Baltimore	MD	Active
DSH210009K	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Neurology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009L	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric -Tourettes	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009M	Child	DSH	JOHNS HOPKINS HOSPITAL	Pediatric Neurology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009N	Child	DSH	JOHNS HOPKINS HOSPITAL	Adult Neurology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009P	Child	DSH	JOHNS HOPKINS HOSPITAL	Cognitive Neurology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009Q	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO- Electromyography	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009R	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO-Epilepsy	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009S	Child	DSH	JOHNS HOPKINS HOSPITAL	NRO- Movement Disorders	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009T	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009U	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro-Vestibular	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009V	Child	DSH	JOHNS HOPKINS HOSPITAL	Neurology-IM/ID	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009W	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro-Pain Treatment Ctr	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009X	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro-Intensive Care	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009Y	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro-Oncology	601 N. Caroline Street	Baltimore	MD	Terminated
DSH210009Z	Child	DSH	JOHNS HOPKINS HOSPITAL	Neuro-Cerebrovascular	601 N. Caroline Street	Baltimore	MD	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/18/2023 8:07:07 AM	9/3/2024 6:15:10 PM	9/3/2024 6:15 PM
Contacts	Primary Contact	Update	PC Change Request	Geize, Shirley Assistant Director, Purchasing and Contracting for Pharmacy The Johns Hopkins Hospital 4109550382	Stimler, David Curtis Assistant Director, Purchasing and Contracting for Pharmacy Johns Hopkins 4105023454	3/30/2024 10:15 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:54:30 AM	8/18/2023 8:07:07 AM	8/18/2023 8:07 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:48:20 AM	8/31/2022 11:54:30 AM	8/31/2022 11:54 AM
Addresses	Billing Address	Insert	Group Change Request		Johns Hopkins Hospital Corporate Accts Payable PO BOX # 33499 Baltimore, MD 21218-0404	4/11/2022 4:09 PM
Contacts	Authorizing Official	Update	Change Request	Smith, Daniel B. CFO Johns Hopkins Hospital 4439971312	Williams, Katina VP CFO The Johns Hopkins Hospital 4105025388	11/19/2021 8:44 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 11:56:02 AM	8/19/2021 10:48:20 AM	8/19/2021 10:48 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (AL)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (AK)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (AS)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (AZ)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (AR)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (CA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (CO)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (CT)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (DE)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (DC)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (FM)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (FL)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (GA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (GU)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (HI)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (ID)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (IL)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (IN)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (IA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (KS)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (KY)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (LA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (ME)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MH)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MI)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MN)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MS)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MO)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MT)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NE)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NV)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NH)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NJ)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NM)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NY)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (NC)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (ND)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (MP)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (OH)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (OK)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (OR)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (PW)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (PA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (PR)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (RI)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (SC)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (SD)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (TN)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (TX)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (UT)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (VT)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (VI)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (VA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (WA)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (WV)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (WI)		8/14/2021 8:07 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578597993 (WY)		8/14/2021 8:07 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (AL)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (AK)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (AS)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (AZ)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (AR)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (CA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (CO)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (CT)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (DE)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (DC)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (FM)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (FL)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (GA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (GU)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (HI)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (ID)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (IL)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (IN)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (IA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (KS)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (KY)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (LA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (ME)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MH)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MI)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MN)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MS)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MO)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MT)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NE)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NV)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NH)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NJ)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NM)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NY)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (NC)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (ND)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (MP)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (OH)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (OK)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (OR)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (PW)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (PA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (PR)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (RI)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (SC)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (SD)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (TN)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (TX)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (UT)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (VT)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (VI)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (VA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (WA)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (WV)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (WI)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000065500 (WY)		7/30/2021 2:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AL	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AS	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AR	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		DE	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		DC	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FM	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GU	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		HI	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ID	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		KS	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ME	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MH	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MN	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MT	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NE	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NV	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NH	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NM	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ND	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MP	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OK	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PW	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PR	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SD	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TX	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		UT	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VT	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VI	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WV	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000065500	9/9/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WY	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		DE	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		SD	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578597993	9/9/2020 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/9/2020 11:56 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1578597993 ( )		9/9/2020 11:56 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 11:55:42 AM	9/9/2020 11:56:02 AM	9/9/2020 11:56 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 8:34:33 AM	9/6/2019 11:55:42 AM	9/6/2019 11:55 AM
Details	Last Recertification Date	Update	Recertification		8/31/2018 8:34:33 AM	8/31/2018 8:34 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Smith, Daniel B. CFO Johns Hopkins Hospital 4439971312	2/8/2018 4:21 PM
Details	340B ID	Update	New Registration		DSH210009JD	2/8/2018 4:21 PM
Details	Entity Subname	Update	New Registration	JHH VRGH ONC INFusion	JHH VRGH ONC INFusion - oncology infusion viragh	2/8/2018 4:21 PM
Dates	Participating Approval Date	Update	New Registration		2/8/2018 4:21:38 PM	2/8/2018 4:21 PM
Details	State	Update	New Registration	Pending	Approved	2/8/2018 4:21 PM
Dates	Signed By Date	Update	New Registration		1/26/2018 4:07:40 PM	2/8/2018 4:21 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	2/8/2018 4:21 PM
Addresses	Main Address	Insert	New Registration		201 North Broadway Baltimore, MD 21231	1/26/2018 11:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/26/2018 11:41 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000065500	1/26/2018 11:41 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	1/26/2018 11:41 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1578597993	1/26/2018 11:41 AM
Contacts	Primary Contact	Insert	New Registration		Geize, Shirley Assistant Director, Purchasing and Contracting for Pharmacy The Johns Hopkins Hospital 4109550382	1/26/2018 11:41 AM
Contacts	Authorizing Official	Insert	New Registration		Smith, Daniel B. CFO Johns Hopkins Hospital 4439971312	1/26/2018 11:41 AM
Details	Last Recertification Date	Insert	New Registration			1/26/2018 11:41 AM
Details	Grant Number	Insert	New Registration			1/26/2018 11:41 AM
Details	340B ID	Insert	New Registration			1/26/2018 11:41 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/26/2018 11:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/26/2018 11:41 AM
Details	Medicare Provider Number	Insert	New Registration		210009	1/26/2018 11:41 AM
Details	Entity Name	Insert	New Registration		JOHNS HOPKINS HOSPITAL	1/26/2018 11:41 AM
Details	Program Code	Insert	New Registration		DSH	1/26/2018 11:41 AM
Details	Entity Subname	Insert	New Registration		JHH VRGH ONC INFusion	1/26/2018 11:41 AM
Dates	Participating Approval Date	Insert	New Registration			1/26/2018 11:41 AM
Details	State	Insert	New Registration		Pending	1/26/2018 11:41 AM
Dates	Registration Date	Insert	New Registration		1/26/2018 11:41:30 AM	1/26/2018 11:41 AM
Dates	Signed By Date	Insert	New Registration			1/26/2018 11:41 AM
Dates	Start Date	Insert	New Registration			1/26/2018 11:41 AM
Terminations	Termination Comments	Insert	New Registration			1/26/2018 11:41 AM
Terminations	Termination Date	Insert	New Registration			1/26/2018 11:41 AM
Terminations	Termination Effective Date	Insert	New Registration			1/26/2018 11:41 AM
Terminations	Termination Reason	Insert	New Registration			1/26/2018 11:41 AM