| Addresses | Shipping Address | Delete | Recertification | New Horizons Healthcare Pharmacy, Valley View
5060 Valley View Blvd
Roanoke, VA 24012 | | 2/13/2025 8:14 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2024 1:19:53 PM | 2/13/2025 8:14:22 AM | 2/13/2025 8:14 AM |
| Contacts | Primary Contact | Update | Change Request | Slaughter, Kimberley Alderman
Pharmacy Director
New Horizons Healthcare
5402832555 | McGinn, Heather Malone
Director
Kuumba Community Health & Wellness Center
5402832552 | 11/15/2024 8:27 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/1/2024 3:15 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1205815420 | 3/1/2024 3:15 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | VA | 3/1/2024 3:15 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1205815420 | 3/1/2024 3:15 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | VA | 3/1/2024 3:15 PM |
| Contacts | Primary Contact | Update | New Registration | Slaughter, Kimberley Alderman
Pharmacy Director
New Horizons Healthcare
5402832555 | Slaughter, Kimberley Alderman
Pharmacy Director
New Horizons Healthcare
5402832555 | 2/28/2024 2:19 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 3:15:47 PM | 2/5/2024 1:19:53 PM | 2/5/2024 1:19 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Stewart, Jonathan jstewart@newhorizonshealthcare.org
Chief Executive Officer
Kuumba Community Health & Wellness Center, Inc. DBA New Horizons Healthcare
5403620360-101 | Stewart, Jonathan
Chief Executive Officer
Kuumba Community Health & Wellness Center, Inc. DBA New Horizons Healthcare
5403620360-101 | 2/6/2023 11:58 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2022 9:37:49 AM | 1/30/2023 3:15:47 PM | 1/30/2023 3:15 PM |
| Contacts | Authorizing Official | Update | Change Request | LEPRO, EILEEN
CEO
New Horizons Healthcare
5403620360-101 | Stewart, Jonathan jstewart@newhorizonshealthcare.org
Chief Executive Officer
Kuumba Community Health & Wellness Center, Inc. DBA New Horizons Healthcare
5403620360-101 | 1/5/2023 6:05 PM |
| Addresses | Shipping Address | Delete | Recertification | New Horizons on 3rd
1215 3rd St. Ste A
Roanoke, VA 24016 | | 2/2/2022 9:37 AM |
| Addresses | Shipping Address | Delete | Recertification | New Horizons Dental Care @ Fralin
321 Tazewell Avenue SE
Roanoke, VA 24013 | | 2/2/2022 9:37 AM |
| Addresses | Main Address | Update | Recertification |
3716 Melrose Ave NW
Roanoke, VA 24017-2716 |
3716 Melrose Avenue NW
Roanoke, VA 24017-2716 | 2/2/2022 9:37 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2021 1:57:36 PM | 2/2/2022 9:37:49 AM | 2/2/2022 9:37 AM |
| Addresses | Shipping Address | Insert | Change Request | | New Horizons Healthcare Pharmacy, Valley View
5060 Valley View Blvd
Roanoke, VA 24012 | 1/27/2022 7:58 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1699029884 ( ) | | 2/4/2021 1:57 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1699029884 | 2/4/2021 1:57 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | VA | 2/4/2021 1:57 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 12:54:33 PM | 2/4/2021 1:57:36 PM | 2/4/2021 1:57 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2019 10:36:25 AM | 1/28/2020 12:54:33 PM | 1/28/2020 12:54 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 2:12:58 PM | 2/13/2019 10:36:25 AM | 2/13/2019 10:36 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2017 12:00:00 AM | 2/9/2018 2:12:58 PM | 2/9/2018 2:12 PM |
| Contacts | Authorizing Official | Update | | LEPRO, EILEEN
CEO
5403620360-101 | LEPRO, EILEEN
CEO
New Horizons Healthcare
5403620360-101 | 2/9/2018 10:00 AM |
| Contacts | Primary Contact | Update | | Slaughter, Kimberley
Pharmacy Director
5402832555 | Slaughter, Kimberley Alderman
Pharmacy Director
New Horizons Healthcare
5402832555 | 10/6/2017 12:06 PM |
| Addresses | Main Address | Insert | | |
3716 Melrose Ave NW
Roanoke, VA 24017-2716 | 2/6/2017 9:21 AM |
| Contacts | Authorizing Official | Insert | | | LEPRO, EILEEN
CEO
5403620360-101 | 2/6/2017 9:21 AM |
| Contacts | Primary Contact | Update | | Schirm, Timothy L.
Pharmacist in Charge
5402832552 | Slaughter, Kimberley
Pharmacy Director
5402832555 | 2/6/2017 9:21 AM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/6/2017 12:00:00 AM | 2/6/2017 9:21 AM |
| Addresses | Shipping Address | Insert | | | New Horizons Healthcare Pharmacy
3716 Melrose Avenue NW
Suite 130
Roanoke, VA 24017 | 12/12/2016 9:01 AM |
| Addresses | Shipping Address | Insert | | | New Horizons on 3rd
1215 3rd St. Ste A
Roanoke, VA 24016 | 12/12/2016 9:01 AM |
| Addresses | Shipping Address | Insert | | | New Horizons Dental Care @ Fralin
321 Tazewell Avenue SE
Roanoke, VA 24013 | 12/12/2016 9:01 AM |
| Details | Last Recertification Date | Update | | 2/16/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 1:30 PM |
| Details | Last Recertification Date | Update | | 3/19/2014 12:00:00 AM | 2/16/2015 12:00:00 AM | 2/16/2015 10:36 PM |
| Contacts | Primary Contact | Update | | LEPRO, EILEEN G.
EXECUTIVE DIRECTOR
5403620360 | Schirm, Timothy L.
Pharmacist in Charge
5402832552 | 4/30/2014 10:39 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/19/2014 1:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1699029884 | 3/19/2014 1:07 PM |
| Medicaid Billing | Medicaid: State | Insert | | | VA | 3/19/2014 1:07 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1699029884 | 3/19/2014 1:07 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/19/2014 12:00:00 AM | 3/19/2014 1:07 PM |
| Details | Entity Name | Update | | KUUMBA COMM HEALTH AND WELLNESS CENTER | KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC. | 3/19/2014 1:07 PM |
| Details | Entity Subname | Update | | | Kuumba Community Health and Wellness Center, Inc. d/b/a New Horizons Healthcare | 3/19/2014 1:07 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/25/2013 9:15 AM |
| Contacts | Primary Contact | Insert | | | LEPRO, EILEEN G.
EXECUTIVE DIRECTOR
5403620360 | 1/22/2010 3:36 PM |
| Details | Last Recertification Date | Insert | | | | 1/22/2010 3:36 PM |
| Details | Grant Number | Insert | | | H80CS00608 | 1/22/2010 3:36 PM |
| Details | 340B ID | Insert | | | CH037480 | 1/22/2010 3:36 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/22/2010 3:36 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/22/2010 3:36 PM |
| Details | Medicare Provider Number | Insert | | | | 1/22/2010 3:36 PM |
| Details | Entity Name | Insert | | | KUUMBA COMM HEALTH AND WELLNESS CENTER | 1/22/2010 3:36 PM |
| Details | Program Code | Insert | | | CH | 1/22/2010 3:36 PM |
| Details | Entity Subname | Insert | | | | 1/22/2010 3:36 PM |
| Dates | Participating Approval Date | Insert | | | 1/22/2010 12:00:00 AM | 1/22/2010 3:36 PM |
| Details | State | Insert | | | Active | 1/22/2010 3:36 PM |
| Dates | Registration Date | Insert | | | 1/1/2001 12:00:00 AM | 1/22/2010 3:36 PM |
| Dates | Signed By Date | Insert | | | | 1/22/2010 3:36 PM |
| Dates | Start Date | Insert | | | 1/1/2001 12:00:00 AM | 1/22/2010 3:36 PM |
| Terminations | Termination Comments | Insert | | | | 1/22/2010 3:36 PM |
| Terminations | Termination Date | Insert | | | | 1/22/2010 3:36 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/22/2010 3:36 PM |
| Terminations | Termination Reason | Insert | | | | 1/22/2010 3:36 PM |
| Details | Comments Public | Insert | | | 2/15/08 UPDATED ADDR (WAS 3716 MELROSE AVENUE, NW, P.O. BOX 6097, 24017) | 1/22/2010 3:36 PM |