Covered Entity Details

DSH090011B MEDSTAR WASHINGTON HOSPITAL CENTER (Active) - information as of 6/14/2025 10:11:16 AM

Main Details

Name

MEDSTAR WASHINGTON HOSPITAL CENTER

Subdivision Name

Colorectal - Colorectal

Type

Disproportionate Share Hospital

Rural

340B ID

DSH090011B

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 Street, NW
POB 2100
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
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	Spence, Clyde E Senior Director Pharmacy Medstar Washington Hospital Center 2028773196	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 10:57 AM
Addresses	Shipping Address	Insert	Change Request		SAFECOR HEALTH 317 NEW BOSTON STREET WOBURN, MA 01801	3/10/2025 10:57 AM
Addresses	Shipping Address	Insert	Change Request		EXTENCARE MEDAC MAIN 7379 WASHINGTON BLVD ELKRIDGE, MD 21075	3/10/2025 10:57 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 10:19:35 AM	8/20/2024 8:36:43 AM	8/20/2024 8:36 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 1:32:51 PM	9/6/2023 10:19:35 AM	9/6/2023 10:19 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1548378235 (VA)		9/7/2022 1:32 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 1:16:25 PM	9/7/2022 1:32:51 PM	9/7/2022 1:32 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1548378235 (VA)		9/7/2021 1:16 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1881701217 (VA)		9/7/2021 1:16 PM
Details	Last Recertification Date	Update	Recertification	8/26/2020 9:45:07 AM	9/7/2021 1:16:25 PM	9/7/2021 1:16 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 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:45 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1548378235	8/26/2020 9:45 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	8/26/2020 9:45 AM
Medicaid Billing	NPI: State	Update	Recertification		VA	8/26/2020 9:45 AM
Medicaid Billing	NPI: State	Update	Recertification		VA	8/26/2020 9:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	8/26/2020 9:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	8/26/2020 9:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548378235	8/26/2020 9:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/26/2020 9:45 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 1:16:50 PM	8/26/2020 9:45:07 AM	8/26/2020 9:45 AM
Addresses	Main Address	Update	Change Request	106 Irving Street, NW POB North 2100 Washington, DC 20010	106 Irving Street, NW POB 2100 Washington, DC 20010	4/13/2020 5:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/27/2019 1:16 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		030015501	8/27/2019 1:16 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		DC	8/27/2019 1:16 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1881701217	8/27/2019 1:16 PM
Details	Last Recertification Date	Update	Recertification		8/27/2019 1:16:50 PM	8/27/2019 1:16 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 4:52 PM
Details	340B ID	Update	New Registration		DSH090011B	6/5/2019 4:52 PM
Details	Entity Name	Update	New Registration	WASHINGTON HOSPITAL CENTER	MEDSTAR WASHINGTON HOSPITAL CENTER	6/5/2019 4:52 PM
Details	Entity Subname	Update	New Registration	Colorectal	Colorectal - Colorectal	6/5/2019 4:52 PM
Dates	Participating Approval Date	Update	New Registration		6/5/2019 4:52:55 PM	6/5/2019 4:52 PM
Details	State	Update	New Registration	Pending	Approved	6/5/2019 4:52 PM
Dates	Signed By Date	Update	New Registration		4/17/2019 1:05:39 PM	6/5/2019 4:52 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	6/5/2019 4:52 PM
Addresses	Main Address	Insert	New Registration		106 Irving Street, NW POB North 2100 Washington, DC 20010	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		030015500	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		DC	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		005045800	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007350990003	4/15/2019 3:49 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/15/2019 3:49 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548378235	4/15/2019 3:49 PM
Contacts	Primary Contact	Insert	New Registration		Kishore, Anil ASSOCIATE DIRECTOR OF PHARMACY Medstar Washington Hospital Center 2028778419	4/15/2019 3:49 PM
Contacts	Authorizing Official	Insert	New Registration		Monge, Catherine Sr Vice President Operations Medstar Washington Hospital Center 2028777454	4/15/2019 3:49 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2019 3:49 PM
Details	Grant Number	Insert	New Registration			4/15/2019 3:49 PM
Details	340B ID	Insert	New Registration			4/15/2019 3:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2019 3:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2019 3:49 PM
Details	Medicare Provider Number	Insert	New Registration		090011	4/15/2019 3:49 PM
Details	Entity Name	Insert	New Registration		WASHINGTON HOSPITAL CENTER	4/15/2019 3:49 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2019 3:49 PM
Details	Entity Subname	Insert	New Registration		Colorectal	4/15/2019 3:49 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2019 3:49 PM
Details	State	Insert	New Registration		Pending	4/15/2019 3:49 PM
Dates	Registration Date	Insert	New Registration		4/15/2019 3:49:28 PM	4/15/2019 3:49 PM
Dates	Signed By Date	Insert	New Registration			4/15/2019 3:49 PM
Dates	Start Date	Insert	New Registration			4/15/2019 3:49 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2019 3:49 PM
Terminations	Termination Date	Insert	New Registration			4/15/2019 3:49 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2019 3:49 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2019 3:49 PM