Covered Entity Details

RRC500005-00 VIRGINIA MASON MEDICAL CENTER (Terminated) - information as of 6/13/2025 2:54:45 PM

Main Details

Name

VIRGINIA MASON MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

Rural

340B ID

RRC500005-00

Medicare Provider Number

500005

Additional Details

Current Program Status

Terminated

Registration Date

7/13/2023

Participating Start Date

10/1/2023

Participating Approval Date

9/11/2023

Last Recertification Date

Termination Date
Termination Reason

1/1/2024
DSH percentage below statutory minimum

Contacts

Authorizing Official

Virginia Mason Franciscan Health
David Nosacka, SVP and CFO
(253) 680-4005

Primary Contact

Virginia Mason Medical Center
Laurel Anne Brown, Director of Pharmacy
(206) 583-6015

Addresses

Street Address

925 SENECA STREET
SEATTLE, WA 98101

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
WA	3315009	1801851258

Shipping Addresses

Same as Street Address

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
Contract Detail	MADRONA PHARMACY	5959 CORSON AVE S STE C1		SEATTLE	WA	98108	10/10/2023	01/01/2024		01/01/2024	01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC500005-01	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ELECTROPHYSIOLOGY (Jones) - ELECTROPHYSIOLOGY (Jones)	1010 Spring St	Seattle	WA	Terminated
RRC500005-02	Child	RRC	VIRGINIA MASON MEDICAL CENTER	GENERAL INTERNAL MEDICINE (Buck) - GENERAL INTERNAL MEDICINE (Buck)	1100 9th Ave, Seattle, WA 98101	Seattle	WA	Terminated
RRC500005-03	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ENDOCRINOLOGY AND DIABETES (Lindeman) - ENDOCRINOLOGY AND DIABETES (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-04	Child	RRC	VIRGINIA MASON MEDICAL CENTER	EMERGENCY DEPARTMENT (Jones) - EMERGENCY DEPARTMENT (Jones)	1010 Spring St	Seattle	WA	Terminated
RRC500005-05	Child	RRC	VIRGINIA MASON MEDICAL CENTER	GI ENDOSCOPY/GASTRIC LAB - BUCK LEVEL 3 - GI ENDOSCOPY/GASTRIC LAB - BUCK LEVEL 3	1100 9th Ave	Seattle	WA	Terminated
RRC500005-06	Child	RRC	VIRGINIA MASON MEDICAL CENTER	HEMATOLOGY AND ONCOLOGY (Buck) - HEMATOLOGY AND ONCOLOGY (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-07	Child	RRC	VIRGINIA MASON MEDICAL CENTER	NEUROLOGY (Lindeman) - NEUROLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-08	Child	RRC	VIRGINIA MASON MEDICAL CENTER	CARDIOTHORACIC (Lindeman) - CARDIOTHORACIC (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-09	Child	RRC	VIRGINIA MASON MEDICAL CENTER	OPHTHALMOLOGY (Buck) - OPHTHALMOLOGY (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-10	Child	RRC	VIRGINIA MASON MEDICAL CENTER	MOHS SURGERY (Lindeman) - MOHS SURGERY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-11	Child	RRC	VIRGINIA MASON MEDICAL CENTER	GI ENDOSCOPY - JONES LEVEL 5 - GI ENDOSCOPY - JONES LEVEL 5	1010 Spring St	Seattle	WA	Terminated
RRC500005-12	Child	RRC	VIRGINIA MASON MEDICAL CENTER	GENERAL GYNECOLOGY (Lindeman) - GENERAL GYNECOLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-13	Child	RRC	VIRGINIA MASON MEDICAL CENTER	FACIAL PLASTICS RECON & COSM (Lindeman) - FACIAL PLASTICS RECON & COSM (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-14	Child	RRC	VIRGINIA MASON MEDICAL CENTER	Federal Way - Outpatient Surgery Center (OSC) - Federal Way - Outpatient Surgery Center (OSC)	33501 1st Way S	Federal Way	WA	Terminated
RRC500005-15	Child	RRC	VIRGINIA MASON MEDICAL CENTER	PLASTIC SURGERY (Lindeman) - PLASTIC SURGERY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-16	Child	RRC	VIRGINIA MASON MEDICAL CENTER	NEPHROLOGY (Buck) - NEPHROLOGY (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-17	Child	RRC	VIRGINIA MASON MEDICAL CENTER	DERMATOLOGY (Lindeman) - DERMATOLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-18	Child	RRC	VIRGINIA MASON MEDICAL CENTER	RHEUMATIC DISEASE (Buck) - RHEUMATIC DISEASE (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-19	Child	RRC	VIRGINIA MASON MEDICAL CENTER	OTOLARYNGOLOGY (Lindeman) - OTOLARYNGOLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-20	Child	RRC	VIRGINIA MASON MEDICAL CENTER	JONES INTEGRATED PROC ADMIT RECOVERY - JONES INTEGRATED PROC ADMIT RECOVERY	1010 Spring St	Seattle	WA	Terminated
RRC500005-21	Child	RRC	VIRGINIA MASON MEDICAL CENTER	GASTROENTEROLOGY (Buck0 - GASTROENTEROLOGY (Buck0	1100 9th Ave	Seattle	WA	Terminated
RRC500005-22	Child	RRC	VIRGINIA MASON MEDICAL CENTER	UROLOGY (Buck) - UROLOGY (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-23	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ORTHOPEDICS - OUTPATIENT (Lindeman) - ORTHOPEDICS - OUTPATIENT (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-24	Child	RRC	VIRGINIA MASON MEDICAL CENTER	FEDERAL WAY - OSC GI - FEDERAL WAY - OSC GI	33501 1st Way S	Federal Way	WA	Terminated
RRC500005-25	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ASTHMA ALLERGY CLINICAL IMMUNOLOGY (Lindeman) - ASTHMA ALLERGY CLINICAL IMMUNOLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-26	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ONCOLOGY INFUSION SERVICE (Buck) - ONCOLOGY INFUSION SERVICE (Buck)	1100 9th Ave	Seattle	WA	Terminated
RRC500005-27	Child	RRC	VIRGINIA MASON MEDICAL CENTER	CONCIERGE MEDICINE (Lindeman) - CONCIERGE MEDICINE (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-28	Child	RRC	VIRGINIA MASON MEDICAL CENTER	NEUROSURGERY (Lindeman) - NEUROSURGERY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-29	Child	RRC	VIRGINIA MASON MEDICAL CENTER	DT SPORTS MED - ORTHO (Lindeman) - DT SPORTS MED - ORTHO (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-30	Child	RRC	VIRGINIA MASON MEDICAL CENTER	NEUROLOGY LABORATORY (Lindeman) - NEUROLOGY LABORATORY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-31	Child	RRC	VIRGINIA MASON MEDICAL CENTER	CARDIOLOGY (Lindeman) - CARDIOLOGY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-32	Child	RRC	VIRGINIA MASON MEDICAL CENTER	FEDERAL WAY - OSC WOUND CARE - FEDERAL WAY - OSC WOUND CARE	33501 1st Way S	Federal Way	WA	Terminated
RRC500005-33	Child	RRC	VIRGINIA MASON MEDICAL CENTER	DT SPORTS MED - PODIATRY (Lindeman) - DT SPORTS MED - PODIATRY (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-34	Child	RRC	VIRGINIA MASON MEDICAL CENTER	EXEC HEALTH PROGRAM (Lindeman) - EXEC HEALTH PROGRAM (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated
RRC500005-35	Child	RRC	VIRGINIA MASON MEDICAL CENTER	ECHOCARDIOGRAPHY LAB (Lindeman) - ECHOCARDIOGRAPHY LAB (Lindeman)	1201 Terry Ave,	Seattle	WA	Terminated
RRC500005-36	Child	RRC	VIRGINIA MASON MEDICAL CENTER	CARDIAC CATH LAB (Jones) - CARDIAC CATH LAB (Jones)	1010 Spring St	Seattle	WA	Terminated
RRC500005-37	Child	RRC	VIRGINIA MASON MEDICAL CENTER	CARDIOVASCULAR LAB (Lindeman) - CARDIOVASCULAR LAB (Lindeman)	1201 Terry Ave	Seattle	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2023 12:00:00 AM	12/11/2023 8:19 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/11/2023 8:19 AM
Terminations	Termination Comments	Update	Termination Request		Hospital is in the process of implementing 340b software only. No 340B drugs were purchased. We terminated as soon as we realized via our cost report that we were no longer eligible.	12/11/2023 8:19 AM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	12/11/2023 8:19 AM
Terminations	Termination Effective Date	Update	Termination Request		11/30/2023 12:00:00 AM	12/11/2023 8:19 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/11/2023 8:19 AM
Addresses	Main Address	Update	Change Request	925 SENECA STREET SEATTLE, WA 98111	925 SENECA STREET SEATTLE, WA 98101	10/31/2023 9:33 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Nosacka, David SVP and CFO Virginia Mason Franciscan Health 2536804005	9/11/2023 11:06 AM
Details	340B ID	Update	New Registration		RRC500005-00	9/11/2023 11:06 AM
Dates	Participating Approval Date	Update	New Registration		9/11/2023 11:06:32 AM	9/11/2023 11:06 AM
Details	State	Update	New Registration	Pending	Approved	9/11/2023 11:06 AM
Dates	Signed By Date	Update	New Registration		8/24/2023 3:27:41 PM	9/11/2023 11:06 AM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	9/11/2023 11:06 AM
Addresses	Main Address	Insert	New Registration		925 SENECA STREET SEATTLE, WA 98111	7/13/2023 10:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2023 10:16 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		3315009	7/13/2023 10:16 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	7/13/2023 10:16 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1801851258	7/13/2023 10:16 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	7/13/2023 10:16 AM
Contacts	Authorizing Official	Insert	New Registration		Nosacka, David SVP and CFO Virginia Mason Franciscan Health 2536804005	7/13/2023 10:16 AM
Contacts	Primary Contact	Insert	New Registration		Brown, Laurel Anne Director of Pharmacy Virginia Mason Medical Center 2065836015	7/13/2023 10:16 AM
Details	Assistance Received From Date	Insert	New Registration			7/13/2023 10:16 AM
Details	Assistance Received To Date	Insert	New Registration			7/13/2023 10:16 AM
Details	Last Recertification Date	Insert	New Registration			7/13/2023 10:16 AM
Details	Grant Number	Insert	New Registration			7/13/2023 10:16 AM
Details	340B ID	Insert	New Registration			7/13/2023 10:16 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2023 10:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2023 10:16 AM
Details	Medicare Provider Number	Insert	New Registration		500005	7/13/2023 10:16 AM
Details	Entity Name	Insert	New Registration		VIRGINIA MASON MEDICAL CENTER	7/13/2023 10:16 AM
Details	NOFO Number	Insert	New Registration			7/13/2023 10:16 AM
Details	Program Code	Insert	New Registration		RRC	7/13/2023 10:16 AM
Details	Entity Subname	Insert	New Registration			7/13/2023 10:16 AM
Dates	Participating Approval Date	Insert	New Registration			7/13/2023 10:16 AM
Details	State	Insert	New Registration		Pending	7/13/2023 10:16 AM
Dates	Registration Date	Insert	New Registration		7/13/2023 10:16:10 AM	7/13/2023 10:16 AM
Dates	Signed By Date	Insert	New Registration			7/13/2023 10:16 AM
Dates	Start Date	Insert	New Registration			7/13/2023 10:16 AM
Terminations	Termination Comments	Insert	New Registration			7/13/2023 10:16 AM
Terminations	Termination Date	Insert	New Registration			7/13/2023 10:16 AM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2023 10:16 AM
Terminations	Termination Reason	Insert	New Registration			7/13/2023 10:16 AM