| Contacts | Primary Contact | Update | Change Request | Williford, Amanda
340B Program Coordinator
Duke University Health System
9196608506 | Gumbrecht, Marcus
340B Clinical Pharmacist
Duke University Health System
9196841791 | 3/17/2025 7:53 AM |
| Contacts | Authorizing Official | Update | Change Request | Sangvai, Devdutta
President
Duke Regional Hospital
9194706153 | Carter, Jason
Chief Operating Officer, Duke Regional Hospital
Duke Regional Hospital
9194706153 | 12/19/2024 10:38 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1235729948 (NC) | | 10/9/2024 2:56 PM |
| Addresses | Shipping Address | Insert | Change Request | | Safecor Health, LLC
4060 Business Park Drive
Columbus, OH 43204 | 9/23/2024 2:07 PM |
| Details | Last Recertification Date | Update | Recertification | 9/11/2023 7:24:28 AM | 8/12/2024 3:11:12 PM | 8/12/2024 3:11 PM |
| Contacts | Primary Contact | Update | Change Request | Petrovskis, Kriss
Director, Pharmacy Business and Revenue Management
Duke University Health System
9196813817 | Williford, Amanda
340B Program Coordinator
Duke University Health System
9196608506 | 8/5/2024 2:06 PM |
| Addresses | Billing Address | Update | Change Request | Duke Accounts Payable
324 Blackwell Street
Box Number 104131
Suite 800
Durham, NC 27708 | Duke Corporate Accounts Payable
Box 104131
Durham, NC 27708 | 10/19/2023 1:48 PM |
| Details | Last Recertification Date | Update | Recertification | 9/19/2022 10:07:59 AM | 9/11/2023 7:24:28 AM | 9/11/2023 7:24 AM |
| Addresses | Shipping Address | Update | Change Request | Duke Regional Hospital Pharmacy Purchasing
3643 North Roxboro Road
Room 1121 First Level
Durham, NC 27704 | Duke Regional Hospital Pharmacy Purchasing
3643 North Roxboro Street
Room 1121 First Level
Durham, NC 27704 | 7/13/2023 6:57 AM |
| Contacts | Authorizing Official | Update | Change Request | Hoy, Jonathan Bradley
CFO
Duke Regional Hospital
9198120672 | Sangvai, Devdutta
President
Duke Regional Hospital
9194706153 | 4/28/2023 7:33 AM |
| Addresses | Main Address | Update | Change Request |
3643 NORTH ROXBORO ROAD
DURHAM, NC 27704-2763 |
3643 NORTH ROXBORO STREET
DURHAM, NC 27704-2763 | 4/10/2023 3:11 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2021 1:51:33 PM | 9/19/2022 10:07:59 AM | 9/19/2022 10:07 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/31/2021 1:51:33 PM | 8/31/2021 1:51 PM |
| Addresses | Billing Address | Update | Change Request | Duke Accounts Payable
324 Blackwell Street, Suite 800
Box Number 104131
Suite 800
Durham, NC 27708 | Duke Accounts Payable
324 Blackwell Street
Box Number 104131
Suite 800
Durham, NC 27708 | 4/30/2021 12:37 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1235729948 | 4/30/2021 12:37 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NC | 4/30/2021 12:37 PM |
| Contacts | Primary Contact | Update | Change Request | Rhea, Francis Eugene
Director, Pharmacy Finance, Business Intelligence and Analytics
Duke University Hospital
9196811172 | Petrovskis, Kriss
Director, Pharmacy Business and Revenue Management
Duke University Health System
9196813817 | 4/30/2021 12:37 PM |
| Details | State | Update | | Approved | Active | 1/1/2021 12:01 AM |
| Details | 340B ID | Update | OPA Edit | DSH340155 | RRC340155-00 | 12/9/2020 7:51 AM |
| Addresses | Billing Address | Insert | New Registration | | Duke Accounts Payable
324 Blackwell Street, Suite 800
Box Number 104131
Suite 800
Durham, NC 27708 | 11/4/2020 8:38 AM |
| Contacts | Signed By | Insert | New Registration | | Hoy, Jonathan Bradley
CFO
Duke Regional Hospital
9198120672 | 11/4/2020 8:38 AM |
| Details | 340B ID | Update | New Registration | | DSH340155 | 11/4/2020 8:38 AM |
| Dates | Participating Approval Date | Update | New Registration | | 11/4/2020 8:38:47 AM | 11/4/2020 8:38 AM |
| Details | State | Update | New Registration | Pending | Approved | 11/4/2020 8:38 AM |
| Dates | Signed By Date | Update | New Registration | | 10/21/2020 8:50:47 AM | 11/4/2020 8:38 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2021 12:00:00 AM | 11/4/2020 8:38 AM |
| Addresses | Main Address | Insert | New Registration | |
3643 NORTH ROXBORO ROAD
DURHAM, NC 27704-2763 | 10/9/2020 1:17 PM |
| Addresses | Billing Address | Insert | New Registration | | Duke Accounts Payable
324 Blackwell Street, Suite 800
Box Number 104131
Suite 800
Durham, NC 27708 | 10/9/2020 1:17 PM |
| Addresses | Shipping Address | Insert | New Registration | | Duke Regional Hospital Pharmacy Purchasing
3643 North Roxboro Road
Room 1121 First Level
Durham, NC 27704 | 10/9/2020 1:17 PM |
| Addresses | Shipping Address | Insert | New Registration | | Duke Regional Hospital Outpatient Pharmacy
3643 North Roxboro Road
Room 33B19 Third Level
Durham, NC 27704 | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1871592113 | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1710986732 | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1811996820 | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1689656480 | 10/9/2020 1:17 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/9/2020 1:17 PM |
| Contacts | Primary Contact | Insert | New Registration | | Rhea, Francis Eugene
Director, Pharmacy Finance, Business Intelligence and Analytics
Duke University Hospital
9196811172 | 10/9/2020 1:17 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Hoy, Jonathan Bradley
CFO
Duke Regional Hospital
9198120672 | 10/9/2020 1:17 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Grant Number | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | 340B ID | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 340155 | 10/9/2020 1:17 PM |
| Details | Entity Name | Insert | New Registration | | DUKE REGIONAL HOSPITAL | 10/9/2020 1:17 PM |
| Details | NOFO Number | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | Program Code | Insert | New Registration | | RRC | 10/9/2020 1:17 PM |
| Details | Entity Subname | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Details | State | Insert | New Registration | | Pending | 10/9/2020 1:17 PM |
| Dates | Registration Date | Insert | New Registration | | 10/9/2020 1:17:34 PM | 10/9/2020 1:17 PM |
| Dates | Signed By Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Dates | Start Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Terminations | Termination Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/9/2020 1:17 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/9/2020 1:17 PM |