Covered Entity Details

DSH090011C MEDSTAR WASHINGTON HOSPITAL CENTER (Active) - information as of 6/14/2025 10:10:39 AM

Main Details

Name

MEDSTAR WASHINGTON HOSPITAL CENTER

Subdivision Name

WIS-National Center for Advanced Pelvic Surgery - Pelvic Surgery

Type

Disproportionate Share Hospital

Rural

340B ID

DSH090011C

Medicare Provider Number

090011

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2019

Participating Start Date

7/1/2019

Participating Approval Date

6/5/2019

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

MedStar Washington Hospital Center
Amanda Lynn Barash, SVP & CFO
(202) 877-6147

Primary Contact

MedStar Washington Hospital Center
Nakita Gary, 340B Program Manager
(202) 877-5260

Addresses

Street Address

106 Irving St. NW
POB 405
Washington, DC 20010

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
DC	030015500,030015501	1548378235
MD	005045800	1548378235
PA	1007350990003	1548378235

Shipping Addresses

Shipping Address 1

MEDSTAR WASHINGTON HOSPITAL CENTER
110 IRVING STREET NW
ROOM B-147
WASHINGTON, DC 20010

Shipping Address 2

SAFECOR HEALTH, LLC
317 NEW BOSTON STREET
WOBURN, MA 01801

Shipping Address 3

EXTENCARE MEDAC MAIN
7379 WASHINGTON BLVD
ELKRIDGE, MD 21075

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
DSH090011A	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	WIS-Perinatal Center - Perinatal Center	106 Irving St. NW	Washington	DC	Active
DSH090011B	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Colorectal - Colorectal	106 Irving Street, NW	Washington	DC	Active
DSH090011C	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	WIS-National Center for Advanced Pelvic Surgery - Pelvic Surgery	106 Irving St. NW	Washington	DC	Active
DSH090011D	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Center for Vascular Care - Vascular	106 Irving Street, NW	Washington	DC	Active
DSH090011E	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Orthopedic - Orthopedic	106 Irving Street, NW	Washington	DC	Active
DSH090011F	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Vascular Lab - Vascular	106 Irving Street, NW	Washington	DC	Active
DSH090011G	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Dermatology - Dermatology	106 Irving Street NW	Washington	DC	Active
DSH090011H	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Podiatry - Podiatry	106 Irving Street NW	Washington	DC	Active
DSH090011J	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Urology - Urology	106 Irving St NW	Washington	DC	Active
DSH090011K	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Maternity/GYN Clinic - Maternity/GYN Clinic	106 Irving Street, N.W.	Washington	DC	Active
DSH090011L	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Surgical Clinic - Surgical Clinic- Endocrine	106 Irving Street, N.W.	Washington	DC	Active
DSH090011M	Child	DSH	MEDSTAR WASHINGTON HOSPITAL CENTER	Otolaryngology - Otolaryngology	106 Irving Street, N.W.	Washington	DC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Evans, Karla D. Director of Pharmacy MedStar Washington Hospital Center 2028777916	Gary, Nakita 340B Program Manager MedStar Washington Hospital Center 2028775260	5/27/2025 6:18 AM
Addresses	Shipping Address	Insert	Change Request		MEDSTAR WASHINGTON HOSPITAL CENTER 110 IRVING STREET NW ROOM B-147 WASHINGTON, DC 20010	3/10/2025 10:58 AM
Addresses	Shipping Address	Insert	Change Request		SAFECOR HEALTH, LLC 317 NEW BOSTON STREET WOBURN, MA 01801	3/10/2025 10:58 AM
Addresses	Shipping Address	Insert	Change Request		EXTENCARE MEDAC MAIN 7379 WASHINGTON BLVD ELKRIDGE, MD 21075	3/10/2025 10:58 AM
Contacts	Primary Contact	Update	Change Request	Spence, Clyde E Senior Director Pharmacy Medstar Washington Hospital Center 2028773196	Evans, Karla D. Director of Pharmacy MedStar Washington Hospital Center 2028777916	3/10/2025 10:58 AM
Contacts	Authorizing Official	Update	AO Change Request	Dubin, Jeffrey Scott Chief Medical Officer Medstar Washington Hospital Center 2028776038	Barash, Amanda Lynn SVP & CFO MedStar Washington Hospital Center 2028776147	1/6/2025 12:46 PM
Contacts	Authorizing Official	Update	Change Request	Gayne, William J Chief Financial Officer Medstar Washington Hopsital Center 2028776147	Dubin, Jeffrey Scott Chief Medical Officer Medstar Washington Hospital Center 2028776038	8/23/2024 7:42 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 10:20:41 AM	8/20/2024 8:34:41 AM	8/20/2024 8:34 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 1:32:04 PM	9/6/2023 10:20:41 AM	9/6/2023 10:20 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1548378235 (VA)		9/7/2022 1:32 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 1:19:12 PM	9/7/2022 1:32:04 PM	9/7/2022 1:32 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1548378235 (VA)		9/7/2021 1:19 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1881701217 (VA)		9/7/2021 1:19 PM
Details	Last Recertification Date	Update	Recertification	8/26/2020 9:46:57 AM	9/7/2021 1:19:12 PM	9/7/2021 1:19 PM
Contacts	Authorizing Official	Update	Change Request	Monge, Catherine Sr Vice President Operations Medstar Washington Hospital Center 2028777454	Gayne, William J Chief Financial Officer Medstar Washington Hopsital Center 2028776147	6/15/2021 3:56 PM
Contacts	Primary Contact	Update	Change Request	Kishore, Anil ASSOCIATE DIRECTOR OF PHARMACY Medstar Washington Hospital Center 2028778419	Spence, Clyde E Senior Director Pharmacy Medstar Washington Hospital Center 2028773196	5/18/2021 4:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:46 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1548378235	8/26/2020 9:46 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	8/26/2020 9:46 AM
Medicaid Billing	NPI: State	Update	Recertification		VA	8/26/2020 9:46 AM
Medicaid Billing	NPI: State	Update	Recertification		VA	8/26/2020 9:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	8/26/2020 9:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	8/26/2020 9:46 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:46 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/26/2020 9:46 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 1:15:19 PM	8/26/2020 9:46:57 AM	8/26/2020 9:46 AM
Addresses	Main Address	Update	Change Request	106 Irving St. NW POB South 405 Washington, DC 20010	106 Irving St. NW POB 405 Washington, DC 20010	4/13/2020 5:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/27/2019 1:15 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		030015501	8/27/2019 1:15 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		DC	8/27/2019 1:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1881701217	8/27/2019 1:15 PM
Details	Last Recertification Date	Update	Recertification		8/27/2019 1:15:19 PM	8/27/2019 1:15 PM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Monge, Catherine Sr Vice President Operations Medstar Washington Hospital Center 2028777454	6/5/2019 4:53 PM
Details	340B ID	Update	New Registration		DSH090011C	6/5/2019 4:53 PM
Details	Entity Name	Update	New Registration	WASHINGTON HOSPITAL CENTER	MEDSTAR WASHINGTON HOSPITAL CENTER	6/5/2019 4:53 PM
Details	Entity Subname	Update	New Registration	WIS-National Center for Advanced Pelvic Surgery	WIS-National Center for Advanced Pelvic Surgery - Pelvic Surgery	6/5/2019 4:53 PM
Dates	Participating Approval Date	Update	New Registration		6/5/2019 4:53:36 PM	6/5/2019 4:53 PM
Details	State	Update	New Registration	Pending	Approved	6/5/2019 4:53 PM
Dates	Signed By Date	Update	New Registration		4/17/2019 1:02:17 PM	6/5/2019 4:53 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	6/5/2019 4:53 PM
Addresses	Main Address	Insert	New Registration		106 Irving St. NW POB South 405 Washington, DC 20010	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		030015500	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		DC	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		005045800	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007350990003	4/15/2019 3:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/15/2019 3:22 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548378235	4/15/2019 3:22 PM
Contacts	Primary Contact	Insert	New Registration		Kishore, Anil ASSOCIATE DIRECTOR OF PHARMACY Medstar Washington Hospital Center 2028778419	4/15/2019 3:22 PM
Contacts	Authorizing Official	Insert	New Registration		Monge, Catherine Sr Vice President Operations Medstar Washington Hospital Center 2028777454	4/15/2019 3:22 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2019 3:22 PM
Details	Grant Number	Insert	New Registration			4/15/2019 3:22 PM
Details	340B ID	Insert	New Registration			4/15/2019 3:22 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2019 3:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2019 3:22 PM
Details	Medicare Provider Number	Insert	New Registration		090011	4/15/2019 3:22 PM
Details	Entity Name	Insert	New Registration		WASHINGTON HOSPITAL CENTER	4/15/2019 3:22 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2019 3:22 PM
Details	Entity Subname	Insert	New Registration		WIS-National Center for Advanced Pelvic Surgery	4/15/2019 3:22 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2019 3:22 PM
Details	State	Insert	New Registration		Pending	4/15/2019 3:22 PM
Dates	Registration Date	Insert	New Registration		4/15/2019 3:22:49 PM	4/15/2019 3:22 PM
Dates	Signed By Date	Insert	New Registration			4/15/2019 3:22 PM
Dates	Start Date	Insert	New Registration			4/15/2019 3:22 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2019 3:22 PM
Terminations	Termination Date	Insert	New Registration			4/15/2019 3:22 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2019 3:22 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2019 3:22 PM