340B Drug Pricing Program Database


RWII70119 NO/AIDS Task Force (d.b.a. CrescentCare) (Active) - information as of 5/29/2025 1:51:54 AM

Main Details
NO/AIDS Task Force (d.b.a. CrescentCare)
CrescentCare - St. Roch
Ryan White Part B
RWII70119
X07HA00018


Additional Details
Active
10/9/2012
1/1/2013
12/17/2012
3/7/2025
10/1/2024 - 9/30/2025

Contacts

NO/AIDS Task Force d.b.a. CrescentCare
Alice Riener, Chief Executive Officer
(504) 821-2601 Ext: 1001

NO/AIDS Task Force d.b.a CrescentCare
Roxanne Hadnott Songy, Director of Compliance
(504) 821-2601 Ext: 1010

Addresses

1631 ELYSIAN FIELDS AVE
NEW ORLEANS, LA 70117

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • History
Comments
CommentLast Updated On 
11/8/12 - Reviewed registration and sent verification email to PO.11/08/2012
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailAVITA PHARMACY 1028340B PARTNERS PHARMACY-DALLAS LLC DBA AV 750 FORT WORTH AVE STE H100
DALLASTX75208-181101/14/201804/01/2018  01/14/2018
Contract DetailAVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011903/14/201304/01/2013  03/28/2013
Contract DetailAVITA PHARMACY 1038AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM 3308 TULANE AVE STE 102
NEW ORLEANSLA70119-717003/29/201604/01/2016  03/29/2016
Contract DetailAVITA PHARMACY 10391631 ELYSIAN FIELDS AVE STE 200
NEW ORLEANSLA70117-820801/03/201904/01/2019  04/01/2019
Contract DetailAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080803/14/201304/01/2013  03/28/2013
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/13/202201/01/2023  01/01/2023
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/13/202201/01/2023  01/01/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/18/202201/01/2023  01/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/13/202201/01/2023  01/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05175 13430 INNERARITY POINT RD
PENSACOLAFL3250710/18/202201/01/2023  01/01/2023
Contract DetailLONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D
LEXINGTONSC29072-245302/19/202102/22/2021  02/22/2021
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10483 1600 ELYSIAN FIELDS AVE.
NEW ORLEANSLA7011704/12/202207/01/2022  07/01/2022
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 167 4401 S CLAIBORNE AVE.
NEW ORLEANSLA7012510/14/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05441 4301 AIRLINE DRIVE
METAIRIELA7000110/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10594 500 N. CARROLLTON AVE.
NEW ORLEANSLA7011910/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05297 201 N. CANAL BLVD.
THIBODAUXLA7030110/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05503 4901 PRYTANIA ST
NEW ORLEANSLA7011510/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05469 2101 COLLINS BLVD.
COVINGTONLA7043310/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.CVS PHARMACY # 16781 4500 VETERANS MEMORIAL BLVD
METAIRIELA7000610/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05349 820 W. ESPLANADE AVE.
KENNERLA7006510/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05442 12589 AIRLINE HWY
DESTREHANLA7004710/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05333 2242 WILLIAMS BLVD.,
KENNERLA7006210/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10145 1401 VETERANS BLVD.
METAIRIELA7000510/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10058 1116 LOUISIANA AVE
NEW ORLEANSLA7011510/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08999 2105 CLEARY AVE.
METAIRIELA7000110/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 8266 2585 LEON C, SIMON DR.
NEW ORLEANSLA7012210/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10108 5902 READ BLVD.
NEW ORLEANSLA7012710/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 6360 1695 HIGHWAY 59
MANDEVILLELA7044810/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05340 9643-B JEFFERSON HWY
RIVER RIDGELA7012310/18/202201/01/2023  01/01/2023
Contract DetailLOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10559 939 GIROD ST., SUITE 160
NEW ORLEANSLA7011310/18/202201/01/2023  01/01/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/18/202201/01/2023  01/01/2023
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #10316 4001 CANAL ST
NEW ORLEANSLA7011904/14/201607/01/2016  04/14/2016
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS SPECIALTY PHARMACY #13777 1415 TULANE AVE STE 2CW07
NEW ORLEANSLA7011204/14/201607/01/2016  04/14/2016
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02262 1100 ELYSIAN FIELDS
NEW ORLEANSLA7011701/14/201804/01/2018  01/14/2018
Contract DetailWALGREEN LOUISIANA CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16395 2000 CANAL ST STE G1-1200
NEW ORLEANSLA7011201/14/201804/01/2018  01/14/2018
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05040 1801 SAINT CHARLES AVE
NEW ORLEANSLA7013001/14/201804/01/2018  01/14/2018
Contract DetailWALGREEN LOUISIANA CO., INC.WALGREENS #17089 760 HARRISON AVE
NEW ORLEANSLA70124-315607/07/201810/01/2018  10/01/2018
Contract DetailWALGREEN LOUISIANA CO., INC.WALGREENS #17110 800 METAIRIE RD STE D
METAIRIELA7000507/07/201810/01/2018  10/01/2018
Contract DetailWALGREEN LOUISIANA CO., INC.WALGREENS #17199 8225 JEFFERSON HWY
HARAHANLA70123-461707/07/201810/01/2018 02/23/202303/21/2023
Contract DetailWALGREEN LOUISIANA CO., INC.WALGREENS #19904 725 VETERANS MEMORIAL BLVD
METAIRIELA70005-287207/07/201810/01/2018 03/21/202305/31/2023
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03139 1826 N BROAD ST
NEW ORLEANSLA7011904/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #15109 4327 JEFFERSON HWY.
JEFFERSONLA7012107/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02468 4545 WEST ESPLANADE
METAIRIELA7000607/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 06506 89 WESTBANK EXPRESSWAY
GRETNALA70053-366207/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03024 4200 CHEF MENTEUR HWY
NEW ORLEANSLA7012607/09/202110/01/2021 01/22/202501/22/2025
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #16312 5702 CROWDER BLVD
NEW ORLEANSLA7012707/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS SPECIALTY PHARMACY #16309 1401 FOUCHER ST STE C-309
NEW ORLEANSLA7011507/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03558 6201 ELYSIAN FIELDS AVE
NEW ORLEANSLA7012207/09/202110/01/2021  10/01/2021
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03889 4110 GENERAL DEGAULLE DR
NEW ORLEANSLA7013110/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 04450 718 S. CARROLLTON AVE.
NEW ORLEANSLA7011810/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05551 619 DECATUR ST
NEW ORLEANSLA7013010/14/202101/01/2022 06/08/202206/08/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 15533 7101 VETERANS MEMORIAL BLVD
METAIRIELA7000310/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05472 821 W ESPLANADE
KENNERLA7006510/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #05866 2418 S. CARROLLTON AVE
NEW ORLEANSLA70118-301210/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #15067 4607 VETERANS MEMORIAL BLVD.
METAIRIELA7000610/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05516 4600 WESTBANK EXPRESSWAY
MARREROLA70072-306510/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 03156 1556 LAPALCO BLVD.
HARVEYLA7005810/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #15571 4501 AIRLINE DR.
METAIRIELA7000110/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11496 101 ALLEN TOUSSAINT BLVD
NEW ORLEANSLA7012410/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 05801 1815 W AIRLINE HWY
LAPLACELA7006810/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 07415 100 W JUDGE PEREZ DRIVE
CHALMETTELA70043-500210/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 02640 3227 MAGAZINE ST
NEW ORLEANSLA7011510/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21205 4200 HOUMA BLVD STE 150
METAIRIELA7000610/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 13658 9705 JEFFERSON HWY
RIVER RIDGELA7012310/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 04451 4400 S.CLAIBORNE AVE.
NEW ORLEANSLA7012510/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #11414 3216 GENTILLY BLVD
NEW ORLEANSLA7012210/14/202101/01/2022  01/01/2022
Contract DetailWALGREEN LOUISIANA CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21176 925 COMMON ST STE A
NEW ORLEANSLA7011210/10/202201/01/2023  01/01/2023
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS #13679 1717 VETERANS MEMORIAL BLVD
METAIRIELA70005-263510/03/202301/01/2024  01/01/2024
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS # 04305 900 CANAL
NEW ORLEANSLA7011201/14/202404/01/2024 01/02/202501/09/2025
Contract DetailWALGREEN LOUISIANA CO., INC.DBA: WALGREENS SPECIALTY PHARMACY #15198 1111 MEDICAL CENTER BLVD STE 116N
MARREROLA7007204/02/202507/01/2025  04/02/2025
Contract DetailWalgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101
MemphisTN3811807/12/202210/01/2022  10/01/2022
Contract DetailWINN DIXIE PHARMACY #1472401 N. CARROLLTON AVE.
NEW ORLEANSLA70119-470204/12/202207/01/2022 12/31/202301/14/2024
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsEntity SubnameUpdateChange RequestCrescentCare - Elysian FieldsCrescentCare - St. Roch4/4/2025 7:05 AM
DetailsLast Recertification DateUpdateRecertification2/6/2024 12:53:20 PM3/7/2025 10:41:01 AM3/7/2025 10:41 AM
DetailsAssistance Received From DateUpdateChange Request10/1/2021 12:00:00 AM10/1/2024 12:00:00 AM11/6/2024 4:42 PM
DetailsAssistance Received To DateUpdateChange Request9/30/2024 12:00:00 AM9/30/2025 12:00:00 AM11/6/2024 4:42 PM
DetailsAssistance Received To DateUpdateRecertification9/30/2023 12:00:00 AM9/30/2024 12:00:00 AM2/6/2024 12:53 PM
DetailsLast Recertification DateUpdateRecertification2/9/2023 10:03:53 AM2/6/2024 12:53:20 PM2/6/2024 12:53 PM
DetailsNOFO NumberUpdate HRSA-20-065 12/16/2023 10:34 AM
DetailsAssistance Received From DateUpdateRecertification10/1/2018 12:00:00 AM10/1/2021 12:00:00 AM2/9/2023 10:03 AM
DetailsAssistance Received To DateUpdateRecertification9/30/2021 12:00:00 AM9/30/2023 12:00:00 AM2/9/2023 10:03 AM
DetailsLast Recertification DateUpdateRecertification2/9/2022 2:28:21 PM2/9/2023 10:03:53 AM2/9/2023 10:03 AM
ContactsAuthorizing OfficialUpdateChange RequestTWILBECK, NOEL John CEO NO/AIDS Task Force (d.b.a. CrescentCare) 5048212601-1000Riener, Alice Chief Executive Officer NO/AIDS Task Force d.b.a. CrescentCare 5048212601-100112/29/2022 9:44 AM
DetailsLast Recertification DateUpdateRecertification2/16/2021 8:53:11 AM2/9/2022 2:28:21 PM2/9/2022 2:28 PM
ContactsPrimary ContactUpdateProfile Change RequestSongy, Roxanne Hadnott Compliance Officer NO/AIDS Task Force d.b.a CrescentCare 5048212601-1010Songy, Roxanne Hadnott Director of Compliance NO/AIDS Task Force d.b.a CrescentCare 5048212601-10107/6/2021 3:43 PM
ContactsPrimary ContactUpdateRecertificationBeard, Jeannette Internal Audit Manager no/aids task force 5048212601-1002Songy, Roxanne Hadnott Compliance Officer NO/AIDS Task Force d.b.a CrescentCare 5048212601-10102/16/2021 8:53 AM
DetailsAssistance Received From DateUpdateRecertification 10/1/2018 12:00:00 AM2/16/2021 8:53 AM
DetailsAssistance Received To DateUpdateRecertification 9/30/2021 12:00:00 AM2/16/2021 8:53 AM
DetailsLast Recertification DateUpdateRecertification2/10/2020 7:56:36 AM2/16/2021 8:53:11 AM2/16/2021 8:53 AM
DetailsNOFO NumberUpdateRecertification HRSA-20-0652/16/2021 8:53 AM
DetailsLast Recertification DateUpdateRecertification2/11/2019 3:19:22 PM2/10/2020 7:56:36 AM2/10/2020 7:56 AM
DetailsGrant NumberUpdateRecertificationEMA-New OrleansX07HA000182/10/2020 7:56 AM
DetailsEntity SubnameUpdateRecertificationCrescentCare Specialty CenterCrescentCare - Elysian Fields2/10/2020 7:56 AM
ContactsPrimary ContactUpdateProfile Change RequestBeard, Jeannette Internal Audit Manager no/aids task force 5048212601-202Beard, Jeannette Internal Audit Manager no/aids task force 5048212601-10022/4/2020 2:08 PM
DetailsLast Recertification DateUpdateRecertification2/12/2018 9:51:16 AM2/11/2019 3:19:22 PM2/11/2019 3:19 PM
AddressesMain AddressUpdateChange Request 2601 TULANE AVENUE 5TH FLOOR NEW ORLEANS, LA 70119 1631 ELYSIAN FIELDS AVE NEW ORLEANS, LA 7011712/10/2018 2:53 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestTWILBECK, NOEL John CEO NO/AIDS Task Force (d.b.a. CrescentCare) 5048212601-228TWILBECK, NOEL John CEO NO/AIDS Task Force (d.b.a. CrescentCare) 5048212601-100012/8/2018 2:23 PM
DetailsLast Recertification DateUpdateRecertification2/17/2017 12:00:00 AM2/12/2018 9:51:16 AM2/12/2018 9:51 AM
ContactsAuthorizing OfficialUpdate TWILBECK, NOEL CEO 5048212601-228TWILBECK, NOEL John CEO NO/AIDS Task Force (d.b.a. CrescentCare) 5048212601-22810/10/2017 7:55 AM
ContactsPrimary ContactUpdate Beard, Jeannette Internal Audit Manager 5048212601-202Beard, Jeannette Internal Audit Manager no/aids task force 5048212601-20210/5/2017 4:37 PM
ContactsPrimary ContactInsert  Beard, Jeannette Internal Audit Manager 5048212601-2028/10/2017 11:48 AM
ContactsAuthorizing OfficialInsert  TWILBECK, NOEL CEO 5048212601-2288/10/2017 11:48 AM
ContactsSigned ByInsert  TWILBECK, NOEL CEO 5048212601-2288/10/2017 11:48 AM
AddressesMain AddressInsert   2601 TULANE AVENUE 5TH FLOOR NEW ORLEANS, LA 701197/7/2017 8:14 AM
DetailsEntity NameUpdate NO/AIDS TASK FORCENO/AIDS Task Force (d.b.a. CrescentCare)7/7/2017 8:14 AM
DetailsLast Recertification DateUpdate 2/25/2016 12:00:00 AM2/17/2017 12:00:00 AM2/17/2017 7:05 PM
DetailsLast Recertification DateUpdate 2/16/2015 12:00:00 AM2/25/2016 12:00:00 AM2/25/2016 6:24 PM
DetailsLast Recertification DateUpdate 2/12/2014 12:00:00 AM2/16/2015 12:00:00 AM2/16/2015 10:21 PM
DetailsEntity SubnameUpdate  CrescentCare Specialty Center2/16/2015 10:21 PM
DetailsLast Recertification DateUpdate  2/12/2014 12:00:00 AM2/12/2014 8:11 PM
Details340B IDUpdate IS-FF-RWII70119ARWII7011912/17/2012 2:54 PM
DatesParticipating Approval DateUpdate  12/17/2012 12:00:00 AM12/17/2012 2:54 PM
DetailsStateUpdate PendingActive12/17/2012 2:54 PM
DatesStart DateUpdate  1/1/2013 12:00:00 AM12/17/2012 2:54 PM
DetailsGrant NumberUpdate  EMA-New Orleans12/17/2012 1:48 PM
Details340B IDUpdate FF HV 11.8.12 #7ONLINE_REGIS-FF-RWII70119A12/17/2012 1:48 PM
Details340B IDUpdate ONLINE_REGFF HV 11.8.12 #7ONLINE_REG11/8/2012 4:37 PM
DetailsComments PublicInsert  11/8/12 - Reviewed registration and sent verification email to PO.11/8/2012 4:37 PM
DetailsLast Recertification DateInsert   10/9/2012 7:06 PM
DetailsGrant NumberInsert   10/9/2012 7:06 PM
Details340B IDInsert  ONLINE_REG10/9/2012 7:06 PM
DetailsIs Authorizing Official EHB DataInsert   10/9/2012 7:06 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/9/2012 7:06 PM
DetailsMedicare Provider NumberInsert   10/9/2012 7:06 PM
DetailsEntity NameInsert  NO/AIDS TASK FORCE10/9/2012 7:06 PM
DetailsProgram CodeInsert  RWII10/9/2012 7:06 PM
DetailsEntity SubnameInsert   10/9/2012 7:06 PM
DatesParticipating Approval DateInsert   10/9/2012 7:06 PM
DetailsStateInsert  Pending10/9/2012 7:06 PM
DatesRegistration DateInsert  10/9/2012 12:00:00 AM10/9/2012 7:06 PM
DatesSigned By DateInsert  10/9/2012 12:00:00 AM10/9/2012 7:06 PM
DatesStart DateInsert   10/9/2012 7:06 PM
TerminationsTermination CommentsInsert   10/9/2012 7:06 PM
TerminationsTermination DateInsert   10/9/2012 7:06 PM
TerminationsTermination Effective DateInsert   10/9/2012 7:06 PM
TerminationsTermination ReasonInsert   10/9/2012 7:06 PM