Covered Entity Details

DSH310027O TRINITAS REGIONAL MEDICAL CENTER (Active) - information as of 5/13/2025 10:57:22 PM

Main Details

Name

TRINITAS REGIONAL MEDICAL CENTER

Subdivision Name

WORK FIRST

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310027O

Medicare Provider Number

310027

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

3/2/2006

Participating Start Date

4/1/2006

Participating Approval Date

3/2/2006

Last Recertification Date

9/1/2024

Contacts

Authorizing Official

Trinitas Regional Medical Center
nancy DiLiegro, VP/coo
(973) 583-0405

Primary Contact

RWJBarnabas Health
Bryan McCormick, Corporate Director 340B Program
(973) 322-4022

Addresses

Street Address

655 EAST JERSEY ST
ELIZABETH, NJ 07206

Billing Address

Trinitas Regional Medical Center
225 Williamson Street
Elizabeth, NJ 07202

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
4/3/12 UPDATED ENTITY NAME (WAS TRINITAS HOSPITAL)	04/03/2012

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
NY	03002715	1073513297
AK	1684542	1073513297
AL	222401	1073513297
AZ	337801	1073513297
CT	8001661	1073513297
DC	14007205	1073513297
FL	910470400	1073513297
GA	003102073A	1073513297
IL	223601678001	1073513297
KY	7100409230	1073513297
MA	110106748A	1073513297
MD	9810081 00	1073513297
NC	3100027	1073513297
OH	2817714	1073513297
PA	1019916650001	1073513297
SC	11197B	1073513297
TX	358599401	1073513297
VA	10050235	1073513297
WI	100058270	1073513297
NJ	7632606	1073513297
CA		1073513297
CO		1073513297
DE		1073513297
ME		1073513297
NH		1073513297
OR		1073513297
MN		1669472882,1770583999
MO		1669472882,1770583999

Shipping Addresses

Shipping Address 1

Trinitas Regional Medical Center
225 Williamson Street
Elizabeth, NJ 07202

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
DSH310027A	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	TRINITAS COMPREHENSIVE CANCER CENTER	225 WILLIAMSON ST, SUITE 124	ELIZABETH	NJ	Active
DSH310027B	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	LINDEN RENAL DIALYSIS	10 NORTH WOOD AVE	LINDEN	NJ	Active
DSH310027C	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	Medical Arts Center Dialysis	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027D	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	PSYCHIATRY	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027E	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	AMBULANCE	225 WILLIAMSON ST	ELIZABETH	NJ	Terminated
DSH310027G	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	WOMEN'S HEALTH CENTER	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027H	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	PEDIATRIC HEALTH CENTER	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027I	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	MEDICAL CLINIC	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027L	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	BROTHER BONAVENTURE	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027M	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	COMMUNITY MOBILE RESPONSE	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027N	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	YOUTH CASE MANAGEMENT/INTENSIVE-IN COMMUNITY	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027O	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	WORK FIRST	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027P	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	EIP (EARLY INTERVENTION PROGRAM)	655 LIVINGSTON STREET	ELIZABETH	NJ	Active
DSH310027Q	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	CHILD DAY TREATMENT - PSYCHIATRY	655 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027R	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	ADULT PSYCH OUTPATIENT CLINIC - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027S	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	ADULT PARTIAL HOSPITAL - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027T	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	SUBSTANCE ABUSE CLINIC - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027U	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	CRANFORD RENAL DIALYSIS - DIALYSIS	205 Birchwood Avenue	Cranford	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 1:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2024 1:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 1:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2024 1:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 1:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2024 1:00 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 1:00 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2024 1:00 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 6:53:34 PM	9/1/2024 1:00:39 PM	9/1/2024 1:00 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 12:32:31 PM	8/21/2023 6:53:34 PM	8/21/2023 6:53 PM
Contacts	Authorizing Official	Update	AO Change Request	DiLiegro, Nancy Vice President of Clinical Operations and Physician Services, Chief Clinical Officer Trinitas regional medical center 9089945226	DiLiegro, nancy VP/coo Trinitas Regional Medical Center 9735830405	4/11/2023 11:19 AM
Contacts	Primary Contact	Update	Recertification	Greasheimer, Sharon DIRECTOR OF PHARMACY Trinitas Regional Medical Center 9089945238	McCormick, Bryan Corporate Director 340B Program RWJBarnabas Health 9733224022	9/15/2022 12:32 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 3:24:39 PM	9/15/2022 12:32:31 PM	9/15/2022 12:32 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 3:32:23 PM	8/18/2021 3:24:39 PM	8/18/2021 3:24 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1073513297 ( )		9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		DE	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/3/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073513297	9/3/2020 3:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/3/2020 3:32 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 12:00:05 PM	9/3/2020 3:32:23 PM	9/3/2020 3:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		03002715	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1684542	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		222401	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		337801	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		8001661	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		14007205	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		910470400	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003102073A	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		223601678001	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100409230	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110106748A	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9810081 00	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3100027	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2817714	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1019916650001	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		11197B	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		358599401	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10050235	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100058270	6/15/2020 11:46 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	6/15/2020 11:46 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 3:34:08 PM	9/5/2019 12:00:05 PM	9/5/2019 12:00 PM
Addresses	Billing Address	Insert	Change Request		Trinitas Regional Medical Center 225 Williamson Street Elizabeth, NJ 07202	6/19/2019 8:48 AM
Addresses	Shipping Address	Insert	Change Request		Trinitas Regional Medical Center 225 Williamson Street Elizabeth, NJ 07202	6/19/2019 8:48 AM
Details	Last Recertification Date	Update	Recertification	11/22/2017 10:03:36 AM	8/27/2018 3:34:08 PM	8/27/2018 3:34 PM
Contacts	Authorizing Official	Update	Change Request	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948174	DiLiegro, Nancy Vice President of Clinical Operations and Physician Services, Chief Clinical Officer Trinitas regional medical center 9089945226	4/24/2018 2:22 PM
Details	Last Recertification Date	Update	Recertification	9/3/2016 12:00:00 AM	11/22/2017 10:03:36 AM	11/22/2017 10:03 AM
Contacts	Authorizing Official	Update	Profile Change Request	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948071	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948174	11/10/2017 7:51 AM
Contacts	Authorizing Official	Update		LUMPP, KAREN CFO & SENIOR VP 9089948071	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948071	11/10/2017 7:49 AM
Contacts	Primary Contact	Update		Greasheimer, Sharon DIRECTOR OF PHARMACY 9089945238	Greasheimer, Sharon DIRECTOR OF PHARMACY Trinitas Regional Medical Center 9089945238	11/9/2017 5:09 PM
Contacts	Authorizing Official	Update		VILLARES, FRANK CFO 9089948071	LUMPP, KAREN CFO & SENIOR VP 9089948071	7/18/2017 9:27 AM
Addresses	Main Address	Insert			655 EAST JERSEY ST ELIZABETH, NJ 07206	7/13/2017 1:35 PM
Contacts	Primary Contact	Update		BENSON, MARLYSE DIRECTOR 9089947634	Greasheimer, Sharon DIRECTOR OF PHARMACY 9089945238	7/13/2017 1:35 PM
Details	Last Recertification Date	Update		8/26/2015 12:00:00 AM	9/3/2016 12:00:00 AM	9/3/2016 1:17 PM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/26/2015 12:00:00 AM	8/31/2015 3:55 PM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/1/2013 7:51 AM
Medicaid Billing	Medicaid: Number	Insert			7632606	10/1/2013 7:51 AM
Medicaid Billing	Medicaid: State	Insert			NJ	10/1/2013 7:51 AM
Medicaid Billing	NPI: Number	Insert			1073513297	10/1/2013 7:51 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/11/2013 12:00:00 AM	9/11/2013 12:49 PM
Contacts	Primary Contact	Insert			BENSON, MARLYSE DIRECTOR 9089947634	5/14/2012 8:50 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 8:50 AM
Details	Entity Name	Update		TRINITAS HOSPITAL	TRINITAS REGIONAL MEDICAL CENTER	4/3/2012 4:53 PM
Details	Comments Public	Insert			4/3/12 UPDATED ENTITY NAME (WAS TRINITAS HOSPITAL)	4/3/2012 4:53 PM
Contacts	Authorizing Official	Insert			VILLARES, FRANK CFO 9089948071	12/21/2011 2:41 PM
Details	Last Recertification Date	Insert				3/2/2006 3:32 PM
Details	Grant Number	Insert				3/2/2006 3:32 PM
Details	340B ID	Insert			DSH310027O	3/2/2006 3:32 PM
Details	Is Authorizing Official EHB Data	Insert				3/2/2006 3:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				3/2/2006 3:32 PM
Details	Medicare Provider Number	Insert			310027	3/2/2006 3:32 PM
Details	Entity Name	Insert			TRINITAS HOSPITAL	3/2/2006 3:32 PM
Details	Program Code	Insert			DSH	3/2/2006 3:32 PM
Details	Entity Subname	Insert			WORK FIRST	3/2/2006 3:32 PM
Dates	Participating Approval Date	Insert			3/2/2006 12:00:00 AM	3/2/2006 3:32 PM
Details	State	Insert			Active	3/2/2006 3:32 PM
Dates	Registration Date	Insert			3/2/2006 12:00:00 AM	3/2/2006 3:32 PM
Dates	Signed By Date	Insert			2/27/2006 12:00:00 AM	3/2/2006 3:32 PM
Dates	Start Date	Insert			4/1/2006 12:00:00 AM	3/2/2006 3:32 PM
Terminations	Termination Comments	Insert				3/2/2006 3:32 PM
Terminations	Termination Date	Insert				3/2/2006 3:32 PM
Terminations	Termination Effective Date	Insert				3/2/2006 3:32 PM
Terminations	Termination Reason	Insert				3/2/2006 3:32 PM