Yes
| VA | | 1811957681,1821403791 |
| NC | | 1811957681,1821403791 |
Sentara Hospitals DBA Sentara Leigh Hospital
830 Kempsville Rd
NORFOLK, VA 23502
Safecor Health
c/o Sentara Leigh Hospital
317 New Boston St
Suite #100
Woburn, MA 01801
| Contract Detail | PROPRIUM PHARMACY | 535 INDEPENDENCE PKWY STE 400 |
| CHESAPEAKE | VA | 23320-5176 | 05/02/2022 | 07/01/2022 | | | 07/01/2022 |
| RRC490046-01 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Endocrinology Specialists - - Kempsville | 850 Kempsville Road | Norfolk | VA | Active |
| RRC490046-02 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Pulmonary, Critical Care & Sleep Specialists - - Kempsville | 844 Kempsville Road | Norfolk | VA | Active |
| RRC490046-03 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Hospitals DBA Sentara Cancer Center - - PET/CT Suite 100 | 6251 E. Virginia Beach Blvd | Norfolk | VA | Active |
| RRC490046-04 | Child | RRC | SENTARA LEIGH HOSPITAL | Ambulatory Surgery Center - (ASC) | 838 Kempsville Road | Norfolk | VA | Active |
| RRC490046-05 | Child | RRC | SENTARA LEIGH HOSPITAL | Noninvasive Echo - 2 | 844 Kempsville Road | Norfolk | VA | Active |
| RRC490046-06 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology PVL - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
| RRC490046-07 | Child | RRC | SENTARA LEIGH HOSPITAL | Nuclear Medicine - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
| RRC490046-08 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology Specialists Leigh - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
| RRC490046-09 | Child | RRC | SENTARA LEIGH HOSPITAL | Walk-in Care Kempsville - Urgent Care | 850 Kempsville Road | Norfolk | VA | Active |
| RRC490046-10 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology Specialists Chesapeake - Cardiology | 713 Volvo Parkway | Chesapeake | VA | Active |
| RRC490046-11 | Child | RRC | SENTARA LEIGH HOSPITAL | Internal Medicine Kempsville - Urgent Care | 850 Kempsville Road | Norfolk | VA | Active |
| Contacts | Authorizing Official | Update | Change Request | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | O'Brien, Tim
Vice President
Sentara Leigh Hospital
7572618610 | 3/18/2025 12:46 PM |
| Addresses | Shipping Address | Update | Change Request | Safecor Health
4060 Business Park Drive
#B
Columbus, OH 43204 | Safecor Health
c/o Sentara Leigh Hospital
317 New Boston St
Suite #100
Woburn, MA 01801 | 3/6/2025 6:43 AM |
| Addresses | Billing Address | Update | Recertification | SENTARA LEIGH HOSPITAL
6015 Poplar Hall Drive
Norfolk, VA 23502 | SENTARA LEIGH HOSPITAL
1300 Sentara Park
Virginia Beach, VA 23464 | 9/4/2024 2:38 PM |
| Addresses | Shipping Address | Delete | Recertification | Safecor
317 New Boston Street
Woburn, MA 01801 | | 9/4/2024 2:38 PM |
| Addresses | Shipping Address | Delete | Recertification | Safecor Health
4060 Business Park Drive
Columbus, OH 43204 | | 9/4/2024 2:38 PM |
| Addresses | Shipping Address | Insert | Recertification | | Safecor Health
4060 Business Park Drive
#B
Columbus, OH 43204 | 9/4/2024 2:38 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2023 12:06:34 PM | 9/4/2024 2:38:54 PM | 9/4/2024 2:38 PM |
| Addresses | Shipping Address | Insert | Change Request | | Safecor Health
4060 Business Park Drive
Columbus, OH 43204 | 1/10/2024 7:04 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1811957681 (VA) | | 1/10/2024 7:04 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1811957681 (NC) | | 1/10/2024 7:04 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1821403791 (VA) | | 1/10/2024 7:04 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1821403791 (NC) | | 1/10/2024 7:04 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 7:11:35 PM | 8/28/2023 12:06:34 PM | 8/28/2023 12:06 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/12/2023 12:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1821403791 | 6/12/2023 12:55 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | VA | 6/12/2023 12:55 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/12/2023 12:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1821403791 | 6/12/2023 12:55 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NC | 6/12/2023 12:55 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1821403791 | 6/12/2023 12:55 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | VA | 6/12/2023 12:55 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1821403791 | 6/12/2023 12:55 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NC | 6/12/2023 12:55 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 5/5/2023 12:48 PM |
| Contacts | Signed By | Update | Profile Change Request | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 5/5/2023 12:48 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/29/2022 7:11:35 PM | 8/29/2022 7:11 PM |
| Details | State | Update | | Approved | Active | 7/1/2022 12:01 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | VA | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NC | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | VA | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NC | 6/13/2022 2:00 PM |
| Addresses | Billing Address | Insert | New Registration | | SENTARA LEIGH HOSPITAL
6015 Poplar Hall Drive
Norfolk, VA 23502 | 5/2/2022 2:30 PM |
| Addresses | Shipping Address | Insert | New Registration | | Sentara Hospitals DBA Sentara Leigh Hospital
830 Kempsville Rd
NORFOLK, VA 23502 | 5/2/2022 2:30 PM |
| Addresses | Shipping Address | Insert | New Registration | | Safecor
317 New Boston Street
Woburn, MA 01801 | 5/2/2022 2:30 PM |
| Contacts | Signed By | Insert | New Registration | | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | 5/2/2022 2:30 PM |
| Details | 340B ID | Update | New Registration | | RRC490046-00 | 5/2/2022 2:30 PM |
| Dates | Participating Approval Date | Update | New Registration | | 5/2/2022 2:30:42 PM | 5/2/2022 2:30 PM |
| Details | State | Update | New Registration | Pending | Approved | 5/2/2022 2:30 PM |
| Dates | Signed By Date | Update | New Registration | | 4/21/2022 3:21:26 PM | 5/2/2022 2:30 PM |
| Dates | Start Date | Update | New Registration | | 7/1/2022 12:00:00 AM | 5/2/2022 2:30 PM |
| Addresses | Main Address | Insert | New Registration | |
830 KEMPSVILLE ROAD
NORFOLK, VA 23502 | 4/7/2022 9:44 AM |
| Addresses | Billing Address | Insert | New Registration | | SENTARA LEIGH HOSPITAL
6015 Poplar Hall Drive
Norfolk, VA 23502 | 4/7/2022 9:44 AM |
| Contacts | Primary Contact | Insert | New Registration | | Lazar, Nicole
Pharmacy Manager - Primary Contact
Sentara Leigh Hospital
7572618037 | 4/7/2022 9:44 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | 4/7/2022 9:44 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Grant Number | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | 340B ID | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Medicare Provider Number | Insert | New Registration | | 490046 | 4/7/2022 9:44 AM |
| Details | Entity Name | Insert | New Registration | | SENTARA LEIGH HOSPITAL | 4/7/2022 9:44 AM |
| Details | NOFO Number | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | Program Code | Insert | New Registration | | RRC | 4/7/2022 9:44 AM |
| Details | Entity Subname | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Details | State | Insert | New Registration | | Pending | 4/7/2022 9:44 AM |
| Dates | Registration Date | Insert | New Registration | | 4/7/2022 9:44:06 AM | 4/7/2022 9:44 AM |
| Dates | Signed By Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Dates | Start Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Terminations | Termination Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/7/2022 9:44 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/7/2022 9:44 AM |