Covered Entity Details

DSH070022AJ YALE NEW HAVEN HOSPITAL (Active) - information as of 4/25/2025 6:31:56 PM

Main Details

Name

YALE NEW HAVEN HOSPITAL

Subdivision Name

YNH HOIT INFUSION ORCHARD

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH070022AJ

Medicare Provider Number

070022

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2014

Participating Start Date

7/1/2014

Participating Approval Date

5/8/2014

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Yale New Haven Health Services
Leeann Miller, Chief Pharmacy Officer
(203) 479-3000

Primary Contact

Yale New Haven Health Services
Andrew Joseph Esposito, Sr. Reimbursement Analyst
(203) 688-1993

Addresses

Street Address

330 Orchard Street
Suite 315
New Haven, CT 06511

Billing Address

Yale-New Haven Hospital
20 York Street
New Haven, CT 06510

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
MA	110066539A,110066539B	1336139500,1578778726
CT	004025128,004041836	1336139500,1578778726
NY	00369686	1336139500,1578778726
RI	YA11183,YA14937	1336139500,1578778726

Shipping Addresses

Shipping Address 1

Yale New Haven Hospital
1450 Chapel Street
New Haven, CT 06511-4405

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
DSH070022A	Child	DSH	YALE NEW HAVEN HOSPITAL	Pediatric Treatment Center	5520 Park Avenue	Trumbull	CT	Active
DSH070022AA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNHCH BH Primary Care Pediatrics	226 Millhill Avenue	Bridgeport	CT	Active
DSH070022AB	Child	DSH	YALE NEW HAVEN HOSPITAL	Primary Care Center	789 Howard Avenue	New Haven	CT	Terminated
DSH070022AC	Child	DSH	YALE NEW HAVEN HOSPITAL	Adler Geriatric Assessment Center	874 Howard Avenue	New Haven	CT	Active
DSH070022AD	Child	DSH	YALE NEW HAVEN HOSPITAL	Winchester Chest Clinic	789 Howard Avenue, 2nd floor	New Haven	CT	Active
DSH070022AE	Child	DSH	YALE NEW HAVEN HOSPITAL	Neurology Movement (Botox)	800 Howard Avenue	New Haven	CT	Active
DSH070022AF	Child	DSH	YALE NEW HAVEN HOSPITAL	Anesthesiology Services	1450 Chapel Street	New Haven	CT	Active
DSH070022AG	Child	DSH	YALE NEW HAVEN HOSPITAL	Radiation Oncology Center	2080 Whitney Avenue	Hamden	CT	Active
DSH070022AH	Child	DSH	YALE NEW HAVEN HOSPITAL	Same Day Admissions (Surgical)	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HOIT INFUSION ORCHARD	330 Orchard Street	New Haven	CT	Active
DSH070022AK	Child	DSH	YALE NEW HAVEN HOSPITAL	OB/GYN Services	1450 Chapel Street	NEW HAVEN	CT	Terminated
DSH070022AL	Child	DSH	YALE NEW HAVEN HOSPITAL	Pediatric Primary Care Center	1450 Chapel Street	NEW HAVEN	CT	Terminated
DSH070022AM	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC HAELEN INF DISEASE ORCHARD	330 Orchard Street	New Haven	CT	Terminated
DSH070022AN	Child	DSH	YALE NEW HAVEN HOSPITAL	Emergency Department	1450 Chapel Street	New Haven	CT	Active
DSH070022AP	Child	DSH	YALE NEW HAVEN HOSPITAL	Electrocardiology Services	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AQ	Child	DSH	YALE NEW HAVEN HOSPITAL	PET Scan Services	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AR	Child	DSH	YALE NEW HAVEN HOSPITAL	Nuclear Medicine	659 George Street	New Haven	CT	Terminated
DSH070022AS	Child	DSH	YALE NEW HAVEN HOSPITAL	MRI Services	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AT	Child	DSH	YALE NEW HAVEN HOSPITAL	CAT Scan Services	330 Orchard Street	New Haven	CT	Terminated
DSH070022AU	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AV	Child	DSH	YALE NEW HAVEN HOSPITAL	Interventional Radiology	1450 Chapel Street	NEW HAVEN	CT	Active
DSH070022AW	Child	DSH	YALE NEW HAVEN HOSPITAL	Adult Primary Care Clinic	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AX	Child	DSH	YALE NEW HAVEN HOSPITAL	Renal Dialysis	1450 Chapel Street	New Haven	CT	Terminated
DSH070022AY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PHOTOPHERESIS SERVICE	15 York Street	New Haven	CT	Active
DSH070022AZ	Child	DSH	YALE NEW HAVEN HOSPITAL	Heart Vascular Center Transition Care	800 Howard Avenue	New Haven	CT	Terminated
DSH070022B	Child	DSH	YALE NEW HAVEN HOSPITAL	Shoreline Radiology	111 Goose Lane	Guilford	CT	Terminated
DSH070022BA	Child	DSH	YALE NEW HAVEN HOSPITAL	Dana Eye Clinic	789 Howard Avenue	New Haven	CT	Active
DSH070022BB	Child	DSH	YALE NEW HAVEN HOSPITAL	MRI Center	801 Howard Avenue	New Haven	CT	Terminated
DSH070022BC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Interventional Psych	184 Liberty Street	NEW HAVEN	CT	Active
DSH070022BD	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology Spine Center	1 Long Wharf Drive	New Haven	CT	Terminated
DSH070022BE	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology	800 Howard Avenue	New Haven	CT	Terminated
DSH070022BF	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology Ped Norwalk	747 Belden Avenue	Norwalk	CT	Terminated
DSH070022BG	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology North Haven	6 Devine Street	North Haven	CT	Terminated
DSH070022BH	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology Ped Long Wharf	1 Long Wharf Drive	New Haven	CT	Terminated
DSH070022BJ	Child	DSH	YALE NEW HAVEN HOSPITAL	Diagnostic Radiology Hamden	2560 Dixwell Avenue	Hamden	CT	Terminated
DSH070022BK	Child	DSH	YALE NEW HAVEN HOSPITAL	Urology Clinic Madison	1291 Boston Post Road Suite 205	Madison	CT	Active
DSH070022BL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROLOGY ORCHARD	330 Orchard Street	New Haven	CT	Active
DSH070022BM	Child	DSH	YALE NEW HAVEN HOSPITAL	Urology Clinic Hamden	2200 Whitney Avenue	Hamden	CT	Active
DSH070022BN	Child	DSH	YALE NEW HAVEN HOSPITAL	TSC GI Motility	6 Devine Street	North Haven	CT	Terminated
DSH070022BP	Child	DSH	YALE NEW HAVEN HOSPITAL	Cardiology Clinic West Haven	764 Campbell Avenue	West Haven	CT	Terminated
DSH070022BQ	Child	DSH	YALE NEW HAVEN HOSPITAL	Westbrook Cardiac Services	5 Pequot Park Road	Westbrook	CT	Terminated
DSH070022BR	Child	DSH	YALE NEW HAVEN HOSPITAL	Heart Vascular Center Outpatient Orange	325 Boston Post Road	Orange	CT	Active
DSH070022BS	Child	DSH	YALE NEW HAVEN HOSPITAL	North Haven Cardiac Services	2 Devine Street Suite 1	North Haven	CT	Active
DSH070022BT	Child	DSH	YALE NEW HAVEN HOSPITAL	Cardiology Clinic Guilford	1591 Boston Post Road	Guilford	CT	Terminated
DSH070022BU	Child	DSH	YALE NEW HAVEN HOSPITAL	Maternal Fetal Medicine at Long Wharf	1 Long Wharf Drive	New Haven	CT	Active
DSH070022BV	Child	DSH	YALE NEW HAVEN HOSPITAL	TSC Endoscopy Suite	6 DEVINE STREET	NORTH HAVEN	CT	Terminated
DSH070022BX	Child	DSH	YALE NEW HAVEN HOSPITAL	Hamden Pediatrics	2080 Whitney Avenue, Suite 250	Hamden	CT	Terminated
DSH070022BY	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Wound Orchard	330 Orchard Street	New Haven	CT	Active
DSH070022BZ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC OR	1450 Chapel Street	New Haven	CT	Terminated
DSH070022C	Child	DSH	YALE NEW HAVEN HOSPITAL	Temple Surgical	111 GOOSE LANE	GUILFORD	CT	Terminated
DSH070022CA	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Gastroenterology	330 Orchard Street	New Haven	CT	Terminated
DSH070022CB	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Main Recovery	1450 Chapel Street	New Haven	CT	ToBeTerminated
DSH070022CC	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Labor and Delivery	1450 Chapel Street	New Haven	CT	Terminated
DSH070022CD	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Fairfield	111 Beach Road	Fairfield	CT	Active
DSH070022CE	Child	DSH	YALE NEW HAVEN HOSPITAL	Intensive Outpatient Psych - Adult	425 George Street	New Haven	CT	Active
DSH070022CF	Child	DSH	YALE NEW HAVEN HOSPITAL	Adolescent Psychiatric IOP	646 George Street	New Haven	CT	Terminated
DSH070022CG	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Trumbull	5520 Park Avenue	Trumbull	CT	Active
DSH070022CH	Child	DSH	YALE NEW HAVEN HOSPITAL	Pedi Hepatology Clinic	800 Howard Avenue	New Haven	CT	Terminated
DSH070022CJ	Child	DSH	YALE NEW HAVEN HOSPITAL	Heart Vascular Center OP Main Branford	84 North Main Street	Branford	CT	Active
DSH070022CK	Child	DSH	YALE NEW HAVEN HOSPITAL	Continuing Care Clinic	1294 Chapel Street	New Haven	CT	Terminated
DSH070022CL	Child	DSH	YALE NEW HAVEN HOSPITAL	Adult Intensive Outpatient/Partial Hospitalization Psych Hamden	2080 Whitney Avenue	Hamden	CT	Active
DSH070022CM	Child	DSH	YALE NEW HAVEN HOSPITAL	Nephrology Clinic	800 Howard Avenue	New Haven	CT	Active
DSH070022CN	Child	DSH	YALE NEW HAVEN HOSPITAL	Old Saybrook Medical Center	633 Middlesex Turnpike	Old Saybrook	CT	Terminated
DSH070022CP	Child	DSH	YALE NEW HAVEN HOSPITAL	Child Partial Hospital Program	15 York Street	New Haven	CT	Terminated
DSH070022CQ	Child	DSH	YALE NEW HAVEN HOSPITAL	Dermatology Clinic	330 Orchard Street	New Haven	CT	Terminated
DSH070022CR	Child	DSH	YALE NEW HAVEN HOSPITAL	Child Psychiatric Intervention Outpatient Program	1450 Chapel Street	New Haven	CT	ToBeTerminated
DSH070022CS	Child	DSH	YALE NEW HAVEN HOSPITAL	Adolescent Psychiatric Intervention Partial Hospital Program Branford	21 Business Park Road	Branford	CT	Active
DSH070022CT	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Electroconvulsive Therapy	330 Orchard Street	New Haven	CT	Terminated
DSH070022CU	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC Vascular	330 Orchard Street	New Haven	CT	Active
DSH070022CV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Pain Management	1 Long Wharf Drive	New Haven	CT	Active
DSH070022CW	Child	DSH	YALE NEW HAVEN HOSPITAL	Neurology MS Center	6 Devine Street	North Haven	CT	Active
DSH070022CX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Neurology ID	15 York Street	New Haven	CT	Approved
DSH070022CZ	Child	DSH	YALE NEW HAVEN HOSPITAL	Neurology MS Center	7 Devine Street	North Haven	CT	Terminated
DSH070022D	Child	DSH	YALE NEW HAVEN HOSPITAL	Temple PACU	111 GOOSE LANE	GUILFORD	CT	Terminated
DSH070022DA	Child	DSH	YALE NEW HAVEN HOSPITAL	Yale New Haven Cardiac Rehab	84 North Main Street	Branford	CT	Active
DSH070022DB	Child	DSH	YALE NEW HAVEN HOSPITAL	Cystic Fibrosis Clinic	789 Howard Avenue	New Haven	CT	Terminated
DSH070022DC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROLOGY YPB 3	800 Howard Avenue	New Haven	CT	Active
DSH070022DD	Child	DSH	YALE NEW HAVEN HOSPITAL	Dana Endocrinology	789 Howard Avenue	New Haven	CT	Active
DSH070022DE	Child	DSH	YALE NEW HAVEN HOSPITAL	Yale New Haven Hospital - Smilow Phase 1 Clinical Trials	55 Park Street	New Haven	CT	Active
DSH070022DF	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK RHEUMATOLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022DG	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW ENDOCRINOLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DH	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW METABOLIC BONE CLINIC	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DJ	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW RHEUMATOLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DK	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPECIALITY CENTER @ TRUMB - CHILDREN'S HEM/ONC AND INFUSION	5520 PARK AVE	TRUMBULL	CT	Active
DSH070022DL	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK NEPHROLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022DM	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW MDA CLINIC	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DN	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW NEUROLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DP	Child	DSH	YALE NEW HAVEN HOSPITAL	MATERNAL FETAL MEDICINE - MATERNAL FETAL MEDICINE ULTRASOUND	1 Long Wharf Drive	New Haven	CT	Terminated
DSH070022DQ	Child	DSH	YALE NEW HAVEN HOSPITAL	PRIMARY CARE CLINIC ADULT - PCC ADULT MED ANCILLARY	789 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022DR	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK UROLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022DS	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW INTERNATIONAL ADOPTION	1 LONG WHARF DR	NEW HAVEN	CT	Terminated
DSH070022DT	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW SPINA BIFIDA	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DU	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW NUTRITION	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DV	Child	DSH	YALE NEW HAVEN HOSPITAL	MFM Perinatology	150 Sargent Drive	NEW HAVEN	CT	Terminated
DSH070022DW	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK ENDOCRINOLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022DX	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK CRANIOFACIAL	747 BELDEN AVE	NORWALK	CT	Active
DSH070022DY	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - GENETICS LW CLINIC	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022DZ	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW ADOLESCENT COMPREHENSIVE	1 LONG WHARF DR	NEW HAVEN	CT	Active
DSH070022E	Child	DSH	YALE NEW HAVEN HOSPITAL	Temple Anesthesia	40 Temple Street	New Haven	CT	Terminated
DSH070022EA	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW GI	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EB	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW NEPHROLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PCC PEDIATRIC CONTINUITY CLINIC	789 HOWARD AVENUE	NEW HAVEN	CT	Terminated
DSH070022ED	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK CARDIOLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EE	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW DEVELOPMENTAL BEHAVIOR	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EF	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - ORTH PEDI LW RESIDENT CLINIC	1 LONG WHARF DR	NEW HAVEN	CT	Terminated
DSH070022EG	Child	DSH	YALE NEW HAVEN HOSPITAL	PRIMARY CARE CLINIC ADULT - PCC ADULT FOOT CLINIC	789 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022EH	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK GENERAL SERVICE	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EJ	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK ORTHO	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EK	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - LW NEONATAL CLINIC	1 LONG WHARF DR	NEW HAVEN	CT	Active
DSH070022EL	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK RESPIRATORY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NORWALK PEDI OPHTHALMOLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EN	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW GENERAL SERVICE	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EP	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW CARDIOLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EQ	Child	DSH	YALE NEW HAVEN HOSPITAL	PRIMARY CARE CLINIC ADULT - PCC ADULT PSYCHIATRY	789 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022ER	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW EPILEPSY PROGRAM	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022ES	Child	DSH	YALE NEW HAVEN HOSPITAL	LIMB PRESERVATION CLINIC	800 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022ET	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK GI	747 BELDEN AVE	NORWALK	CT	Active
DSH070022EU	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK NUTRITION	747 BELDEN AVE	NORWALK	CT	Terminated
DSH070022EV	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW DIABETES	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH LW GENDER PROGRAM	1 Long Wharf Drive, 2nd Floor	NEW HAVEN	CT	Active
DSH070022EX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PCC PEDIATRIC DERMATOLOGY	789 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022EY	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW SURGERY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022EZ	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK SURGERY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022F	Child	DSH	YALE NEW HAVEN HOSPITAL	Shoreline Nuclear Medicine	111 Goose Lane	Guilford	CT	Terminated
DSH070022FA	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW IMMUNO/ALLERGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022FB	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW CRANIOFACIAL CLINIC	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022FC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH LW Bariatric Surgery	1 LONG WHARF DR	NEW HAVEN	CT	Terminated
DSH070022FD	Child	DSH	YALE NEW HAVEN HOSPITAL	MATERNAL FETAL MEDICINE - MATERNAL FETAL MEDICINE ANESTHESIA	1 Long Wharf Drive	New Haven	CT	Active
DSH070022FE	Child	DSH	YALE NEW HAVEN HOSPITAL	PRIMARY CARE CLINIC ADULT - PCC ADULT EVENING CLINIC	789 HOWARD AVENUE	New Haven	CT	Terminated
DSH070022FF	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK NEUROLOGY	747 BELDEN AVE	NORWALK	CT	Active
DSH070022FG	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDI SPECIALITY TREATMENT CENTER - PEDI NORWALK ADOLESCENT COMP	747 BELDEN AVE	NORWALK	CT	Terminated
DSH070022FH	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - ORTH LW PEDI SPECIALTY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022FJ	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW UROLOGY	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022FK	Child	DSH	YALE NEW HAVEN HOSPITAL	PEDIATRIC SPEC CTR @ 1 LONG WHARF - PEDI LW SPASTICITY CENTER	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022FL	Child	DSH	YALE NEW HAVEN HOSPITAL	MATERNAL FETAL MEDICINE - MATERNAL FETAL MEDICINE LONG WHARF	20 York Street	New Haven	CT	Terminated
DSH070022FM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Pediatric Care Clinic (PCC) - YNH Pediatric PCC Continuity Clinic	20 York Street	New Haven	CT	Terminated
DSH070022FN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CH SLEEP STUDY	20 York Street	New Haven	CT	Terminated
DSH070022FP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PCC PEDIATRIC GENERAL CLINIC - YNH PCC PEDIATRIC GENERAL CLINIC	789 HOWARD AVENUE	NEW HAVEN	CT	Terminated
DSH070022FQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH BRANFORD CARDIAC SERVICES - YNH BRANFORD CARDIAC SERVICES	84 NORTH MAIN STREET	BRANFORD	CT	Terminated
DSH070022FR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HEART VASCULAR CENTER OP GUILFORD - YNH HEART VASCULAR CENTER OP GUILFORD	1591 BOSTON POST ROAD	GUILFORD	CT	Terminated
DSH070022FS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SLEEP CENTER NORTH HAVEN - YNH SLEEP CENTER NORTH HAVEN	8 DEVINE STREET	NORTH HAVEN	CT	Active
DSH070022FT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH BRANFORD AMBULATORY CARDIOLOGY - YNH BRANFORD AMBULATORY CARDIOLOGY	84 NORTH MAIN STREET	BRANFORD	CT	Terminated
DSH070022FU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SLEEP CENTER MADISON - SLEEP CLINIC	1291 BOSTON POST ROAD	MADISON	CT	ToBeTerminated
DSH070022FV	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC MCGIVNEY PREOP/PACU - PRE-OP/PACU SERVICES	1450 CHAPEL STREET	NEW HAVEN	CT	Terminated
DSH070022FW	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PERIOP SVCS MCGIVNEY OR - PERIOPERATIVE SERVICES	1450 CHAPEL STREET	NEW HAVEN	CT	Active
DSH070022FX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB MCGIVNEY - REHAB CLINIC	1450 CHAPEL STREET	NEW HAVEN	CT	Active
DSH070022FY	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC BARIATRICS ORCHARD - BARIATRICS CLINIC	330 Orchard Street, MOB2	NEW HAVEN	CT	Terminated
DSH070022FZ	Child	DSH	YALE NEW HAVEN HOSPITAL	DEVINE ST BONE DENSITY - RADIOLOGY SERVICES - BONE DENSITY	6 DEVINE STREET	NORTH HAVEN	CT	Terminated
DSH070022G	Child	DSH	YALE NEW HAVEN HOSPITAL	Temple Radiology	60 Temple Street	New Haven	CT	Terminated
DSH070022GA	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC RHEUMATOLOGY CLINIC - RHEUMATOLOGY CLINIC	1450 CHAPEL STREET	NEW HAVEN	CT	Terminated
DSH070022GB	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC ORTHOPEDICS - ORTHOPEDIC SERVICE	330 ORCHARD STREET	NEW HAVEN	CT	Terminated
DSH070022GC	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC MINOR OP SURGERY - MINOR OUTPATIENT SURGERY	330 ORCHARD STREET	NEW HAVEN	CT	Terminated
DSH070022GD	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC EYE LASER EXAM - SRC EYE LASER EXAM CLINIC	330 ORCHARD STREET	NEW HAVEN	CT	Terminated
DSH070022GE	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC FOOT AND ANKLE - SRC FOOT AND ANKLE CLINIC	330 ORCHARD STREET	NEW HAVEN	CT	Active
DSH070022GF	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PLASTIC SURGERY - PLASTIC SURGERY SERVICE	330 ORCHARD STREET	NEW HAVEN	CT	Active
DSH070022GG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIOLOGY GENETICS CLINIC - GENETICS OP CLINIC	800 HOWARD AVENUE	NEW HAVEN	CT	ToBeTerminated
DSH070022GH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TXP INFECT DISEASE NEW HAVEN - TRANSPLANT CLINIC - INFECTIOUS DISEASE	800 HOWARD AVENUE	NEW HAVEN	CT	Active
DSH070022GJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ORAL MAXILLOFACIAL SURG - PEDI DENTAL SERVICES	1 LONG WHARF DRIVE	NEW HAVEN	CT	Terminated
DSH070022GK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ADULT DENTAL - NH HOWARD AVE - ADULT DENTAL CLINIC	789 HOWARD AVE	NEW HAVEN	CT	Terminated
DSH070022GL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI DENTAL - LONG WHARF - PEDIATRIC DENTAL CLINIC	1 LONG WHARF DRIVE	NEW HAVEN	CT	Terminated
DSH070022GM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ADULT DENTAL - LONG WHARF - ADULT DENTAL CLINIC	1 LONG WHARF DRIVE	NEW HAVEN	CT	Terminated
DSH070022GN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ADULT DENTAL - HAMDEN DIXWELL - ADULT DENTAL CLINIC	2560 DIXWELL AVE	HAMDEN	CT	Terminated
DSH070022GP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ORAL MAXILLOFACIAL SURGERY - DENTAL SERVICES	330 ORCHARD STREET	NEW HAVEN	CT	Terminated
DSH070022GQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ORAL MAXILLOFACIAL SURGERY LW - ADULT DENTAL SERVICES	1 LONG WHARF DRIVE	NEW HAVEN	CT	Terminated
DSH070022GR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SPINE CENTER LONG WHARF - SPINE CLINIC	1 Long Wharf Drive	New Haven	CT	Active
DSH070022GS	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PEDIATRIC PRIMARY CARE FOSTER CARE CLINIC - PRIMARY CARE	1450 Chapel Street	NEW HAVEN	CT	Terminated
DSH070022GT	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC HVC PRE/POST RECOVERY - PRE/POST RECOVERY HEART VASCULAR	20 York Street	NEW HAVEN	CT	Terminated
DSH070022GU	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC TRAUMA ORCHARD - TRAUMA SERVICE	20 York Street	NEW HAVEN	CT	Terminated
DSH070022GV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CV PREVENTION & FELLOWS CLINIC - CARDIOLOGY CLINIC	20 York Street	NEW HAVEN	CT	Terminated
DSH070022GW	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC MATERNAL FETAL MEDICINE - MATERNAL FETAL MEDICINE UNIT	1450 CHAPEL STREET	NEW HAVEN	CT	Terminated
DSH070022GX	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC EKG/EEG - EKG/EEG SERVICE	20 York Street	NEW HAVEN	CT	Terminated
DSH070022GY	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PULMONARY MEDICINE - PULMONARY MEDICINE	20 York Street	NEW HAVEN	CT	Terminated
DSH070022GZ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC REHAB NEW HAVEN - Rehabilitation	175 Sherman Avenue	New Haven	CT	Active
DSH070022H	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Therapeutic Radiation Shoreline Clinic	111 Goose Lane	Guilford	CT	Active
DSH070022HA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ARTHRITIS & RHEUMATIC DISEASE - Rheumatology	6 Devine Street	North Haven	CT	Active
DSH070022HB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI LW RESPIRATORY - Pediatric Respiratory	1 Long Wharf Drive, Suite 202	New Haven	CT	Active
DSH070022HC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH YPB CARDIAC SERVICES - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Active
DSH070022HD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SHORELINE SURGERY PERIOP SVCS - YNH SHORELINE SURGERY PERIOP SVCS	111 Goose Lane	GUILFORD	CT	Active
DSH070022HE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SHORELINE PREOP/PACU - YNH SHORELINE PREOP/PACU	111 Goose Lane	GUILFORD	CT	ToBeTerminated
DSH070022HF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH RAD ONC GI MDC NORTH HAVEN - Radiation Oncology	6 Devine Street, 4th Floor	NORTH HAVEN	CT	Terminated
DSH070022HG	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC CARDIAC REHAB - SHERMAN - Cardiac Rehabilitation	175 Sherman Avenue, 2nd Floor	New Haven	CT	Active
DSH070022HH	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC MAIN 6 SURGERY - SRC MAIN 6 SURGERY	1450 Chapel Street	New Haven	CT	Terminated
DSH070022HJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SPINE REHAB - Rehabilitation	1 Long Wharf Drive	New Haven	CT	Terminated
DSH070022HK	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC AMBULATORY HVC ORCHARD - Cardiovascular Disease	330 Orchard Street	NEW HAVEN	CT	Active
DSH070022HL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TXP LIVING DONOR CENTER YPB3 - Transplant	800 Howard Avenue, 3rd Floor	NEW HAVEN	CT	Active
DSH070022HM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH INT IMM INFUSION DEVINE - Infusion Therapy	6 Devine Street	North Haven	CT	Active
DSH070022HN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ORANGE CARDIAC SERVICES - CANH - Cardiovascular Disease	325 Boston Post Road	Orange	CT	Active
DSH070022HP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NORTH HAVEN ENDOSCOPY - YNH NORTH HAVEN ENDOSCOPY	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022HQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIOTHORACIC SURGERY - Cardiothoracic Surgery	800 Howard Avenue, 2nd Floor	New Haven	CT	Active
DSH070022HR	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC ENDOSCOPY - SRC ENDOSCOPY	1450 Chapel Street	New Haven	CT	Active
DSH070022HS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EP CARDIOLOGY SERVICE - Cardiovascular Disease	800 Howard Avenue, 2nd Floor	New Haven	CT	Active
DSH070022HT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW UROLOGIC ONCOLOGY NH - Urology	6 Devine Street	NORTH HAVEN	CT	Approved
DSH070022HU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PALLIATIVE NORTH HAVEN - Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022HV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB SERVICES PEDI - Rehabilitation	1 Long Wharf Drive Suite 202	New Haven	CT	Active
DSH070022HW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH MATERNAL FETAL MEDICINE NORWALK	747 Belden Avenue	Norwalk	CT	Active
DSH070022HX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TRANSPLANT - DERMATOLGY - Transplant	800 Howard Avenue, 4th Floor	New Haven	CT	Active
DSH070022HY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB UROLOGY YPB 3 - Rehabilitation	800 Howard Avenue	NEW HAVEN	CT	Active
DSH070022HZ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC REHAB SERVICES CHAPEL - Rehabilitation	1450 Chapel Street	New Haven	CT	Active
DSH070022J	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Emergency Department Shoreline	111 Goose Lane	Guilford	CT	Active
DSH070022JA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH AMB CARDIOLOGY SERVICE - Cardiovascular Disease	800 Howard Avenue, 2nd Floor	New Haven	CT	Active
DSH070022JB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW BREAST ONCOLOGY NORTH HAVEN - Oncology	6 Devine Street	NORTH HAVEN	CT	Terminated
DSH070022JC	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PODIATRY - Podiatry	330 Orchard Street	New Haven	CT	Terminated
DSH070022JD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI YPB CARDIAC SERVICES - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Active
DSH070022JE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN GEN ADOLES LONG WHARF - Pediatric Gynecology	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022JF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB MILFORD - Rehabilitation	48 Wellington Road	Milford	CT	Active
DSH070022JG	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC MCGIVNEY OR - SRC MCGIVNEY OR	1450 Chapel Street	New Haven	CT	Approved
DSH070022JH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SHORELINE SURGICAL CENTER - YNH SHORELINE SURGICAL CENTER	111 Goose Lane	GUILFORD	CT	Active
DSH070022JJ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC SHORT-TERM SURGERY - SRC SHORT-TERM SURGERY	1450 Chapel Street	New Haven	CT	ToBeTerminated
DSH070022JK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TXP INFUSION CENTER - Infusion Therapy	800 Howard Avenue 4th Floor	New Haven	CT	Active
DSH070022JL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW HEMATOLOGY NORTH HAVEN - Hematology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022JM	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC NUC MED CARDIOLOGY - Cardiovascular Disease	1450 Chapel Street	New Haven	CT	Active
DSH070022JN	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC CARDIAC CATH EP - Cardiovascular Disease	1450 Chapel Street	New Haven	CT	Active
DSH070022JP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Approved
DSH070022JQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO NORTH HAVEN - Oncology	6 Devine Street	NORTH HAVEN	CT	Approved
DSH070022JR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO WATERBURY - Oncology	1075 Chase Parkway	WATERBURY	CT	Terminated
DSH070022JS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO DERBY - Oncology	350 Seymour Ave	DERBY	CT	Terminated
DSH070022JT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO ORANGE - Oncology	240 Indian River Road	ORANGE	CT	Terminated
DSH070022JU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIOLOGY MFM LONG WHARF - Obstetrics and Gynecology	1 Long Wharf Drive, 2nd Floor	NEW HAVEN	CT	Active
DSH070022JV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PALLIATIVE WATERBURY - Oncology	1075 Chase Parkway	WATERBURY	CT	Active
DSH070022JW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROGYN ONC YPB 3 - Uro-Gynecology	800 Howard Avenue	NEW HAVEN	CT	Active
DSH070022JX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NORWALK ENT - Otolaryngology	747 Belden Avenue	NORWALK	CT	Active
DSH070022JY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PALLIATIVE DERBY - Oncology	350 Seymour Avenue	Derby	CT	Active
DSH070022JZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW HEAD & NECK 55 PARK - Complex General Surgical Oncology	55 Park Street	NEW HAVEN	CT	Active
DSH070022K	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Care Center - North Haven	6 Devine Street	North Haven	CT	Active
DSH070022KA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW NEURO MEDICAL ONC NH - Oncology	6 Devine Street	NORTH HAVEN	CT	Approved
DSH070022KB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PHASE I - Oncology	Smilow Cancer Hospital	New Haven	CT	Terminated
DSH070022KC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PRENATAL GENETICS PROGRAM - Genetics	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022KD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW GI ONCOLOGY NH - Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022KE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH RHEUMATOLOGY LONG WHARF - Rheumatology	1 Long Wharf Drive, 6th Floor	New Haven	CT	Approved
DSH070022KF	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PULMONARY REHAB - BRANFORD - Pulmonary Disease	84 North Main Street 2nd Floor	Branford	CT	Active
DSH070022KG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW THORACIC ONCOLOGY NH - Thoracic Surgery	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022KH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH WINCHESTER CHEST CLINIC DANA 2 - Pulmonary Disease	789 Howard Avenue	NEW HAVEN	CT	Terminated
DSH070022KJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW MELANOMA NH - Oncology	6 Devine Street	NORTH HAVEN	CT	Terminated
DSH070022KK	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC GENERAL SURGERY AND TRAUMA ORCHARD - General Surgery	330 Orchard Street, 2nd Floor	New Haven	CT	Approved
DSH070022KL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW BREAST ONCOLOGY GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Active
DSH070022KM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW MALIG HEME NORTH HAVEN - Hematology and Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022KN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH LW PSYCH GENDER PROGRAM - Psychiatry	1 Long Wharf Drive, 2nd Floor	NEW HAVEN	CT	Active
DSH070022KP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI LW UROLOGY DSD - Pediatric Urology	1 Long Wharf Drive, 2nd Floor	New Haven	CT	Active
DSH070022KQ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC ECHOCARDIOGRAPHY - Cardiovascular Disease	1450 Chapel Street	New Haven	CT	Active
DSH070022KR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PLASTIC WOUND - HOWARD AVE - Plastic Surgery	800 Howard Avenue, 2nd Floor	New Haven	CT	Terminated
DSH070022KS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC BRANFORD CARDIAC SERVICES - Cardiovascular Disease	84 North Main Street	Branford	CT	Active
DSH070022KT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW GYN ONCOLOGY WATERBURY - Oncology	1075 Chase Parkway	WATERBURY	CT	Active
DSH070022KU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TRANSPLANT - CARDIOLOGY - Transplant	800 Howard Avenue, 4th Floor	New Haven	CT	Active
DSH070022KV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI LW NEUROSURGERY - Pediatric Neurosurgery	1 Long Wharf Drive, Suite 202	New Haven	CT	Active
DSH070022KW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIOLOGY GENETICS CLINIC - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Terminated
DSH070022KX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW GUILFORD - Oncology	111 Goose Lane Suite 1300	Guilford	CT	Terminated
DSH070022KY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB SERVICES GUILFORD - Rehabilitation	1445 Boston Post Road	Guilford	CT	Active
DSH070022KZ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PICC SERVICES - IV Infusion	1450 Chapel Street	New Haven	CT	Terminated
DSH070022L	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Care Center - Guilford	111 Goose Lane	Guilford	CT	Active
DSH070022LA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENT LW NEW HAVEN - Otolaryngology	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022LB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ORTHOPEDICS NORTH HAVEN - Orthopedic Surgery	6 Devine Street	NORTH HAVEN	CT	Terminated
DSH070022LC	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC ECT - Psychiatry	330 Orchard Street	New Haven	CT	Terminated
DSH070022LD	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC EKG/EEG - SRC EKG/EEG	1450 Chapel Street	New Haven	CT	Terminated
DSH070022LE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIAC SERVICES GOOSE LANE GUILFORD - CANH - Cardiovascular Disease	111 Goose Lane	GUILFORD	CT	Active
DSH070022LF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW SU BREAST-NORTH HAVEN - Complex General Surgical Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022LG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH GYN ONCOLOGY GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Terminated
DSH070022LH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW MELANOMA GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Active
DSH070022LJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO WATERFORD - Oncology	230 Waterford Parkway S	WATERFORD	CT	Terminated
DSH070022LK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW WATERBURY - Oncology	1075 Chase Parkway Suite B	Waterbury	CT	Active
DSH070022LL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ADULT CONGENITAL HEART - Pediatric Cardiology	800 Howard Avenue	New Haven	CT	Active
DSH070022LM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH WOMEN'S INFUSION GUILFORD - Infusion Therapy	111 Goose Lane	GUILFORD	CT	Terminated
DSH070022LN	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC HAELEN INF DISEASE - Infectious Diseases	1450 Chapel Street	New Haven	CT	Terminated
DSH070022LP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH VASCULAR SURGERY - Vascular Surgery	800 Howard Avenue, 2nd Floor	New Haven	CT	Active
DSH070022LQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PHASE I INFUSION 55 PARK - Oncology	55 Park Street	NEW HAVEN	CT	Active
DSH070022LR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC OP GOOSE LANE GUILFORD - Cardiovascular Disease	111 Goose Lane	GUILFORD	CT	Active
DSH070022LS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ENDOCRINOLOGY - NORTH HAVEN - Endocrine Medicine	6 Devine Street	North Haven	CT	Active
DSH070022LT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH AORTIC CENTER - Cardiovascular Disease	789 Howard Avenue	New Haven	CT	Terminated
DSH070022LU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PM&R CMC NORTH HAVEN - Physical Medicine and Rehabilitation	6 Devine Street	North Haven	CT	Terminated
DSH070022LV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC OP WESTBROOK - Cardiovascular Disease	5 Pequot Park Road	Westbrook	CT	Terminated
DSH070022LW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH GI SURGERY NORTH HAVEN - Colon & Rectal Surgery	6 Devine Street	NORTH HAVEN	CT	Terminated
DSH070022LX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW SU BREAST-SHORELINE - Complex General Surgical Oncology	111 Goose Lane	Guilford	CT	Active
DSH070022LY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC OP NORTH HAVEN - Cardiovascular Disease	2 Devine Street	North Haven	CT	Active
DSH070022LZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PALLIATIVE GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Active
DSH070022M	Child	DSH	YALE NEW HAVEN HOSPITAL	Women's Center	789 Howard Avenue	New Haven	CT	Terminated
DSH070022MA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW PALLIATIVE ORANGE - Oncology	240 Indian River Road	ORANGE	CT	ToBeTerminated
DSH070022MB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI AUDIOLOGY NORWALK - Audiology	747 Belden Avenue	NORWALK	CT	Active
DSH070022MC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CARDIOLOGY VALVE CLINIC - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Active
DSH070022MD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PAIN MGMT NORTH HAVEN - Pain Medicine	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022ME	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC CATH/EP HOLDING - Cardiovascular Disease	1450 Chapel Street	New Haven	CT	Terminated
DSH070022MF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW MED ONC INFUSION NH - Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022MG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NORWALK DIABETES - YNH PEDI NORWALK DIABETES	747 Belden Avenue	Norwalk	CT	Active
DSH070022MH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ALLERGY/IMMUNOLOGY - Allergy and Immunology	6 Devine Street Suite 2B	North Haven	CT	Active
DSH070022MJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NORTH HAVEN GI MOTILITY - YNH NORTH HAVEN GI MOTILITY	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022MK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEUROLOGY EEG - Neurology	789 Howard Avenue Suite Fitkin 230	New Haven	CT	Active
DSH070022ML	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH AMB INTERVENTIONAL RADIOLOGY - Vascular and Interventional Radiology	800 Howard Avenue	New Haven	CT	Active
DSH070022MM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW LIVER CANCER CLINIC NH - Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022MN	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC REHAB HAMDEN - Rehabilitation	2080 Whitney Avenue	Hamden	CT	Active
DSH070022MP	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC GI LAB - SRC GI LAB	1450 Chapel Street	New Haven	CT	Terminated
DSH070022MQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CONGESTIVE HEART FAILURE - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Active
DSH070022MR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NEPHROLOGY TRANSPLANT - Pediatric Nephrology	800 Howard Avenue, 4th Floor	NEW HAVEN	CT	Active
DSH070022MS	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC EAR NOSE AND THROAT - Otolaryngology	330 Orchard Street	New Haven	CT	Active
DSH070022MT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH VASCULAR SURGERY NORTH HAVEN - Vascular Surgery	2 Devine Street	NORTH HAVEN	CT	Active
DSH070022MU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ALLERGY IMMUNOLOGY NORWALK - Pediatric Allergy and Immunology	747 Belden Ave	NORWALK	CT	Active
DSH070022MV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC OP GUILFORD - Cardiovascular Disease	111 Goose Lane	Guilford	CT	Terminated
DSH070022MW	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC GENERAL SURGERY MOB - General Surgery	330 Orchard Street, 2nd Floor	New Haven	CT	Terminated
DSH070022MX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH GI SURGERY YPB 3 - Colon & Rectal Surgery	800 Howard Avenue 3rd Floor	NEW HAVEN	CT	ToBeTerminated
DSH070022MY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEUROSURGERY NORTH HAVEN FLR1 - Neurological Surgery	6 Devine Street, 1st Floor	North Haven	CT	Terminated
DSH070022MZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROLOGY ORANGE - Urology	240 Indian River Road, Suite A1	Orange	CT	Terminated
DSH070022N	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Care Center - Waterbury	1075 Chase Parkway	Waterbury	CT	Terminated
DSH070022NA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH DIGESTIVE HEALTH DEVINE - Gastroenterology	6 Devine Street, Suite 2B	North Haven	CT	Terminated
DSH070022NB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEUROLOGY INFUSION FAIRFIELD - Infusion Therapy	75 Kings Highway	FAIRFIELD	CT	Active
DSH070022NC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB SERVICES YPB - Rehabilitation	800 Howard Avenue	New Haven	CT	Active
DSH070022ND	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW TOBACCO TRUMBULL PARK - Oncology	5520 PARK AVENUE	TRUMBULL	CT	Approved
DSH070022NE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ORTHO TRUMBULL - Pediatric Orthopedic Surgery	5520 Park Avenue, WP-G 600	TRUMBULL	CT	Active
DSH070022NF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL DIABETES - Endocrinology, Diabetes & Metabolism	5520 Park Avenue	Trumbull	CT	Active
DSH070022NG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL ENDOCRINOLOGY - Pediatric Endocrinology	5520 Park Avenue	Trumbull	CT	Active
DSH070022NH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL NEUROLOGY - Neurology with Special Qualification in Child Neu*	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022NJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL PULMONARY FUNCTION TEST - Pediatric Pulmonology	5520 Park Avenue	Trumbull	CT	Approved
DSH070022NK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL RESPIRATORY - Pediatric Respiratory	5520 Park Avenue	Trumbull	CT	Active
DSH070022NL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDIATRIC SPECIALISTS - HEN - Pediatrics	5520 Park Avenue	Trumbull	CT	Active
DSH070022NM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENT TRUMBULL - Otolaryngology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022NN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL CARDIOLOGY - Pediatric Cardiology	5520 Park Avenue	Trumbull	CT	Active
DSH070022NP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL CRANFIOFACIAL CLINIC - Plastic Surgery	5520 Park Ave	TRUMBULL	CT	Approved
DSH070022NQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL GENERAL SERVICES - Pediatrics	5520 Park Avenue	Trumbull	CT	Active
DSH070022NR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL GI - Pediatric Gastroenterology	5520 Park Avenue	Trumbull	CT	Active
DSH070022NS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL NEPHROLOGY - Pediatric Nephrology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022NT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL SURGERY - General Surgery	5520 Park Avenue	Trumbull	CT	Active
DSH070022NU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN GEN ADOLES PARK TRUMBULL - Pediatric Gynecology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022NV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI UROLOGY PARK AVE - Pediatric Urology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022NW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ALLERGY AND IMMUNOLOGY OLD SAYBROOK - Pediatric Allergy and Immunology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022NX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI AUDIOLOGY OLD SAYBROOK - Pediatric Audiology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022NY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI DIABETES OLD SAYBROOK - Endocrinology, Diabetes & Metabolism	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022NZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINOLOGY OLD SAYBROOK - Pediatric Endocrinology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022P	Child	DSH	YALE NEW HAVEN HOSPITAL	Guilford Cardiology	111 Goose Lane	Guilford	CT	Terminated
DSH070022PA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI HEM/ONC OLD SAYBROOK - Pediatric Hematology and Oncology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NEONATAL OLD SAYBROOK - Neonatal-Perinatal Medicine	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NEUROLOGY OLD SAYBROOK - Neurology with Special Qualification in Child Neu*	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI RESPIRATORY OLD SAYBROOK - Pediatric Respiratory	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI UROLOGY OLD SAYBROOK - Pediatric Urology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI AERODIGESTIVE OLD SAYBROOK - Pediatric Respiratory	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NEPHROLOGY OLD SAYBROOK - Pediatric Nephrology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ORTHO OLD SAYBROOK - Pediatric Orthopedic Surgery	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI CARDIOLOGY OLD SAYBROOK - Pediatric Cardiology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ECHOCARDIOGRAPHY OLD SAYBROOK - Cardiovascular Disease	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENT OLD SAYBROOK - Otolaryngology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GEN SERVICE - OLD SAYBROOK - Pediatrics	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GI OLD SAYBROOK - Pediatric Gastroenterology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NEUROSURGERY OLD SAYBROOK - Pediatric Neurosurgery	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI OLD SAYBROOK NUTRITION - Pediatric Nutrition	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI RHEUMATOLOGY OLD SAYBROOK - Pediatric Rheumatology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI SURGERY OLD SAYBROOK - Pediatric Surgery	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROLOGY OLD SAYBROOK - Urology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH REHAB OLD SAYBROOK - Rehabilitation	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TXP INFUSION CENTER OLD SAYBROOK - Infusion Therapy	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022PW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NUTRITION CLINIC SCRANTON - Nutrition	200 Orchard Street	NEW HAVEN	CT	Terminated
DSH070022PX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI HEPATOLOGY - Pediatric Hepatology	800 Howard Avenue	New Haven	CT	Approved
DSH070022PY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ALLERGY AND IMMUNOLOGY OLD SAYBROOK - Allergy and Immunology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022PZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH RHEUMATOLOGY & ARTHRITIS OLD SAYBROOK - Rheumatology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022Q	Child	DSH	YALE NEW HAVEN HOSPITAL	Diabetes Center	789 Howard Avenue	New Haven	CT	Active
DSH070022QA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ENT OLD SAYBROOK - Otolaryngology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SURGERY COMM DIS OLD SAYBROOK - Audiology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH FATTY LIVER CLINIC OLD SAYBROOK - Gastroenterology	633 Middlesex Turnpike	OLD SAYBROOK	CT	ToBeTerminated
DSH070022QD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH AMB CARDIOLOGY OLD SAYBROOK - Cardiovascular Disease	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022QE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC PROCEDURES OLD SAYBROOK - Vascular and Interventional Radiology	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022QF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEPHROLOGY OLD SAYBROOK - Nephrology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW OLD SAYBROOK - Oncology	633 Middlesex Turnpike	Old Saybrook	CT	Terminated
DSH070022QH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH TXP INT MED OLD SAYBROOK - Transplant	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QJ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC HVC PRE/POST RECOVERY - Cardiovascular Disease	1450 Chapel Street	New Haven	CT	ToBeTerminated
DSH070022QK	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PULMONARY MEDICINE - Pulmonary Disease	1450 Chapel Street	New Haven	CT	Active
DSH070022QL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EMG OLD SAYBROOK - Neurology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PM&R CMC OLD SAYBROOK - Physical Medicine and Rehabilitation	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022QN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI TRUMBULL NUTRITION - Pediatric Nutrition	5520 Park Avenue	Trumbull	CT	Active
DSH070022QP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EMG NORTH HAVEN - Neurology	6 Devine Street	North Haven	CT	Terminated
DSH070022QQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNHCH BH SLEEP STUDY - Sleep Medicine	267 Grant Street	BRIDGEPORT	CT	Active
DSH070022QR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PHOTOTHERAPY - Dermatology	46 Prince Street	New Haven	CT	Active
DSH070022QS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CV PREVENTION & FELLOWS CLINIC - Cardiovascular Disease	800 Howard Avenue	New Haven	CT	Active
DSH070022QT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PULMONARY FUNCTION TESTING - Pulmonary Disease	789 Howard Avenue	New Haven	CT	Active
DSH070022QU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EMG LONG WHARF - Neurology	1 Long Wharf Drive	New Haven	CT	Active
DSH070022QV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH INT IMM INFUSION OLD SAYBROOK - Infusion Therapy	633 Middlesex Turnpike	Old Saybrook	CT	Active
DSH070022QW	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC AMB INTERVENTIONAL RADIOLOGY - Vascular and Interventional Radiology	1450 Chapel Street	New Haven	CT	Terminated
DSH070022QX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI CSC LONG WHARF - Psychiatry	1 Long Wharf Drive, Suite 202	NEW HAVEN	CT	Active
DSH070022QY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI LONG WHARF PULMONARY FUNCTION TESTING - Pediatric Pulmonology	1 Long Wharf Drive, Suite 202	NEW HAVEN	CT	Approved
DSH070022QZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI AUDIOLOGY LONG WHARF - Audiology	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022R	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Transplant Internal Medicine New Haven	800 Howard Avenue	New Haven	CT	Active
DSH070022RA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ADOLESCENT CLINIC - Adolescent Medicine	789 Howard Avenue	New Haven	CT	Terminated
DSH070022RB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEUROPHYSIOLOGY - Neurology	789 Howard Avenue, 2nd floor, Fitkin 230	New Haven	CT	Active
DSH070022RC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH DIGESTIVE HEALTH DANA 2 - Gastroenterology	789 Howard Avenue	NEW HAVEN	CT	Active
DSH070022RD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH GI SURGERY DANA 2 - Colon & Rectal Surgery	789 Howard Avenue	NEW HAVEN	CT	Active
DSH070022RE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN FAMILY PLANNING HOWARD AVE - Obstetrics and Gynecology	789 Howard Avenue, Tompkins Building	New Haven	CT	Terminated
DSH070022RF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NORWALK PULMONARY FUNCTION TESTING - Pediatric Pulmonology	747 Belden Ave	NORWALK	CT	Approved
DSH070022RG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW GI SURGERY NORTH HAVEN - Complex General Surgical Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022RH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH WINCHESTER CHEST CLINIC 6 DEVINE - Pulmonary Disease	6 Devine Street, 3rd floor	NORTH HAVEN	CT	Active
DSH070022RJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PULMONARY FUNCTION TESTING 6 DEVINE - Pulmonary Disease	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022RK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ALLERGY IMMUNOLOGY TRUMBULL - Pediatric Allergy and Immunology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022RL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW HEAD & NECK MDC TRUMBULL - Otolaryngology	5520 Park Avenue	TRUMBULL	CT	ToBeTerminated
DSH070022RM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PLASTICS BREAST TRUMBULL - Plastic Surgery	5520 Park Avenue, Suite 1-500	TRUMBULL	CT	Terminated
DSH070022RN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI AUDIOLOGY TRUMBULL - Audiology	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022RP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GENDER PROG OLD SAYBROOK - Pediatrics	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022RQ	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC OP SERVICES CONTINUING CARE CLINIC - GEORGE ST - Behavioral Health	646 George Street	New Haven	CT	Active
DSH070022RR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI NORWALK NUTRITION - Pediatric Nutrition	747 Belden Avenue	Norwalk	CT	Active
DSH070022RS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HYPERTENSION CENTER - Cardiovascular Disease	800 Howard Avenue 2nd Floor	New Haven	CT	Terminated
DSH070022RT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH DERMATOLOGY NORTH HAVEN - Dermatology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022RU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GUILFORD TREATMENT CENTER - Pediatrics	405 Church Street	Guilford	CT	Terminated
DSH070022RW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ADOLESCENT TRUMBULL - Pediatrics	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022RX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GENDER PROG TRUMBULL - Pediatrics	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022RY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE OBESITY LONG WHARF - Pediatric Endocrinology	1 Long Wharf Drive, Suite 202	New Haven	CT	Active
DSH070022RZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI HEPATOLOGY TRUMBULL - Pediatric Hepatology	5520 Park Avenue, Garden Level	TRUMBULL	CT	Active
DSH070022S	Child	DSH	YALE NEW HAVEN HOSPITAL	Spine Rehab Center	1 Long Wharf Drive	New Haven	CT	Active
DSH070022SA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI PCOS TRUMBULL - Pediatrics	5520 Park Avenue	TRUMBULL	CT	Active
DSH070022SB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE TYPE 2 DIABETES TRUMBULL - Pediatric Endocrinology	5520 Park Avenue	Trumbull	CT	Active
DSH070022SC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE TYPE 2 DIABETES LW - Pediatric Endocrinology	1 Long Wharf Drive, Suite 202	New Haven	CT	Active
DSH070022SD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI MDE FOSTER CARE CLINIC - Pediatrics	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022SE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE OBESITY NORWALK - Pediatric Endocrinology	747 Belden Avenue	Norwalk	CT	Active
DSH070022SF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE OBESITY OLD SAYBROOK - Pediatric Endocrinology	633 Middlesex Turnpike	Old Saybrook	CT	ToBeTerminated
DSH070022SJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EMG YPB - Neurology	Yale Physician's Building	New Haven	CT	Active
DSH070022SK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NEUROLOGY - Neurology	6 Devine Street	North Haven	CT	Terminated
DSH070022SL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH AMB IR OLD SAYBROOK - Vascular and Interventional Radiology	633 Middlesex Tpke	Old Saybrook	CT	Active
DSH070022SM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NUTRITION CLINIC - Nutrition	789 Howard Ave	New Haven	CT	Active
DSH070022SN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH NUTRITION CLINIC SARGENT DRIVE - Nutrition	150 Sargent Drive, Room 2113 & 2114	New Haven	CT	Active
DSH070022SP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH MATERNAL WELLNESS PROGRAM LW - Social Work	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022SQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH MFM PSYCH CLINIC LW - Psychiatry	1 Long Wharf Drive	NEW HAVEN	CT	Active
DSH070022ST	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROGYN MADISON - Uro-Gynecology	1291 Boston Post Rd,	MADISON	CT	Active
DSH070022SU	Child	DSH	YALE NEW HAVEN HOSPITAL	SRC PROJECT MOTHER CARE - WHEAT - Obstetrics and Gynecology	674 Washington Ave	West Haven	CT	Terminated
DSH070022SV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH VASCULAR SURGERY GUILFORD - Vascular Surgery	111 Goose lane	Guilford	CT	Active
DSH070022SW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH MATERNAL WELLNESS PROGRAM - Social Work	236 Boston Post Road	ORANGE	CT	ToBeTerminated
DSH070022SX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC PREVENTATIVE CARDIOLOGY HEALTH - Cardiovascular Disease	175 Sherman Ave	NEW HAVEN	CT	Active
DSH070022SY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PROJECT MOTHER CARE - Obstetrics and Gynecology	789 Howard Avenue	NEW HAVEN	CT	Active
DSH070022SZ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN GEN ADOLES OLD SAYBROOK - Pediatric Gynecology	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022T	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Care Center - Derby	350 Seymour Avenue	Derby	CT	Active
DSH070022TA	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH CHILDRENS DAY HOSPITAL IOP - Psychiatry	350 George Street	New Haven	CT	Active
DSH070022TB	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH EXECUTIVE HEALTH YPB - Internal Medicine	800 Howard Avenue	NEW HAVEN	CT	Active
DSH070022TC	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH SMILOW HEMA ORANGE - Hematology	240 Indian River Road	ORANGE	CT	Active
DSH070022TD	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH DIG HLTH NUTRITION WESTBROOK - Nutrition	5 Pequot Park Road	WESTBROOK	CT	Active
DSH070022TE	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH INTEGRATIVE MEDICINE NORTH HAVEN - Oncology	6 Devine Street	NORTH HAVEN	CT	Active
DSH070022TF	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC DISEASE MGMT 800 HOWARD - Cardiovascular Disease	800 Howard Avenue	NEW HAVEN	CT	Active
DSH070022TG	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH UROLOGY SERVICE - Urology	800 Howard Avenue 3rd Floor	New Haven	CT	ToBeTerminated
DSH070022TH	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC DISEASE MGMT GUILFORD - Cardiovascular Disease	111 Goose Lane	Guilford	CT	Active
DSH070022TJ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN UROGYN GUILFORD - Uro-Gynecology	111 Goose Lane	GUILFORD	CT	Active
DSH070022TK	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH HVC DISEASE MGMT DEVINE ST - Cardiovascular Disease	2 Devine Street Suite 1	North Haven	CT	Active
DSH070022TL	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH INTEGRATIVE MEDICINE GUILFORD - Oncology	111 Goose Lane	GUILFORD	CT	Active
DSH070022TM	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI LW BARIATRIC SURGERY - Pediatric Surgery	1 Long Wharf Drive, Suite 202	New Haven	CT	Active
DSH070022TN	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH OBGYN GEN ADOLES NORWALK - Pediatric Gynecology	747 BELDEN AVENUE	NORWALK	CT	Active
DSH070022TP	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PHOTOTHERAPY WESTBROOK - Dermatology	5 Pequot Park Rd	WESTBROOK	CT	Active
DSH070022TQ	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH DIGESTIVE HEALTH WESTBROOK - Gastroenterology	5 Pequot Park Road	WESTBROOK	CT	Active
DSH070022TR	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH GI SURGERY WESTBROOK - Colon & Rectal Surgery	5 Pequot Park Road	WESTBROOK	CT	Active
DSH070022TS	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH BARIATRIC SURGERY WESTBROOK - Bariatric Medicine	5 Pequot Park Road	WESTBROOK	CT	Active
DSH070022TT	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH INTEGRATIVE MEDICINE WATERBURY - Oncology	1075 Chase Parkway	WATERBURY	CT	Active
DSH070022TU	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH MATERNAL WELLNESS 789 HOWARD - Social Work	789 Howard Avenue	NEW HAVEN	CT	Active
DSH070022TV	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI ENDOCRINE OBESITY TRUMBULL - Pediatric Endocrinology	5520 Park Avenue	Trumbull	CT	Active
DSH070022TW	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH PEDI GYN HEME TRUMBULL - Multidisciplinary	5520 Park Avenue	Trumbull	CT	Active
DSH070022TX	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH VASCULAR SURGERY OLD SAYBROOK - Vascular Surgery	633 Middlesex Tpke	Old Saybrook	CT	Active
DSH070022TY	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH ORTHOPEDICS OLD SAYBROOK - Orthopedic Surgery	633 Middlesex Turnpike	OLD SAYBROOK	CT	Active
DSH070022V	Child	DSH	YALE NEW HAVEN HOSPITAL	Pediatric Specialty Clinic Norwalk	747 Belden Avenue	Norwalk	CT	Terminated
DSH070022W	Child	DSH	YALE NEW HAVEN HOSPITAL	YNH Comprehensive Infectious Disease	200 Orchard St	New Haven	CT	Active
DSH070022X	Child	DSH	YALE NEW HAVEN HOSPITAL	Smilow Care Center - Orange	240 Indian River Road	Orange	CT	Active
DSH070022Y	Child	DSH	YALE NEW HAVEN HOSPITAL	Pediatric Specialty Clinic Long Wharf	1 Long Wharf Drive	New Haven	CT	Terminated
DSH070022Z	Child	DSH	YALE NEW HAVEN HOSPITAL	Obstetrics,Gynecology & Reproductive Services	150 Sargent Drive	New Haven	CT	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 3:58:29 PM	9/5/2024 5:54:31 PM	9/5/2024 5:54 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 12:22:26 PM	8/31/2023 3:58:29 PM	8/31/2023 3:58 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (CA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	3104859 (NH)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	14271009 (NJ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10019A (SC)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10242B (SC)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (AL)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	210998105 (AR)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (AZ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1578778726 (AZ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	9000154300 (CO)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	017673700 (DC)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (DE)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000230062X (GA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (IA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (ID)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	060646652001 (IL)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100466040A (IN)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	200332570E (KS)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1748552 (LA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	009555900 (MD)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	157310100 (ME)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (MI)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (MS)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1578778726 (MS)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0452132 (MT)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10025481801 (NE)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (NV)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (OH)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1578778726 (OH)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	292866 (OR)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0070022 (TN)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	071742301 (TX)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	009815562 (VA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	060646652 (VI)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0070022 (VT)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	2077634 (WA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0007894900001 (PA)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	97630705 (NM)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	022286 (AZ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	108404800 (FL)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (ME)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	12355707 (MO)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (NC)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (NH)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	4080602 (NJ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1336139500 (NJ)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0145042 (OH)		6/5/2023 9:27 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	80648300 (WI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (CA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (FL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (FL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (NH)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (NH)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (NJ)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (NJ)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (PA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (PA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (SC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (SC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (AL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (AL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (AR)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (AR)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (AZ)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (AZ)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (CO)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (CO)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (DC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (DC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (DE)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (DE)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (GA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (GA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (IA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (IA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (ID)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (ID)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (IL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (IL)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (IN)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (IN)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (KS)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (KS)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (LA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (LA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (MD)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (MD)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (ME)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (ME)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (MI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (MI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (MO)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (MO)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (MS)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (MS)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (MT)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (MT)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (NC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (NC)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (NE)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (NE)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (NV)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (NV)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (OH)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (OH)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (OR)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (OR)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (TN)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (TN)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (TX)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (TX)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (VA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (VA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (VI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (VI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (VT)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (VT)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (WA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (WA)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (WI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578778726 (WI)		6/5/2023 9:27 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1336139500 (CA)		6/5/2023 9:27 AM
Contacts	Authorizing Official	Update	Change Request	Messina, Mary G Director, Regulatory Reimbursement YNHHS Yale New Haven Health System 2036888543	Miller, Leeann Chief Pharmacy Officer Yale New Haven Health Services 2034793000	10/5/2022 6:59 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	092603500 (FL)		9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1336139500 (RI)		9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1336139500 (MO)		9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	9700022 (NC)		9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1336139500 (WI)		9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		022286	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		108404800	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336139500	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		ME	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		12355707	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336139500	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336139500	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NH	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4080602	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336139500	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0145042	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		YA11183	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		YA14937	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		80648300	9/15/2022 12:22 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/15/2022 12:22 PM
Details	Last Recertification Date	Update	Recertification	9/20/2021 6:33:11 AM	9/15/2022 12:22:26 PM	9/15/2022 12:22 PM
Addresses	Main Address	Update	Recertification	330 Orchard Street New Haven, CT 06511	330 Orchard Street Suite 315 New Haven, CT 06511	9/20/2021 6:33 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 1:55:53 PM	9/20/2021 6:33:11 AM	9/20/2021 6:33 AM
Details	Entity Subname	Update	Recertification	HOIT Unit	YNH HOIT INFUSION ORCHARD	9/20/2021 6:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/9/2021 1:16 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		97630705	8/9/2021 1:16 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NM	8/9/2021 1:16 PM
Contacts	Primary Contact	Update	Profile Change Request	Esposito, Andrew Joseph Sr. Reimbursement Analyst Yale New Haven Health Services 2033762610	Esposito, Andrew Joseph Sr. Reimbursement Analyst Yale New Haven Health Services 2036881993	4/21/2021 9:27 AM
Contacts	Primary Contact	Update	Change Request	Messina, Mary G Director, Regulatory Reimbursement YNHHS Yale New Haven Health System 2036888543	Esposito, Andrew Joseph Sr. Reimbursement Analyst Yale New Haven Health Services 2033762610	3/31/2021 10:00 AM
Contacts	Authorizing Official	Update	Change Request	Loftus, Michael Vice President - Finance Yale New Haven Hospital 2032003833	Messina, Mary G Director, Regulatory Reimbursement YNHHS Yale New Haven Health System 2036888543	3/16/2021 1:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Messina, Mary G Senior Manager, Regulatory Reimbursement Yale New Haven Health System 2036888543	Messina, Mary G Director, Regulatory Reimbursement YNHHS Yale New Haven Health System 2036888543	3/11/2021 2:38 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1578778726 (CA)		10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0369686 (NY)		10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	000789490001 (PA)		10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1336V139500 (RI)		10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	YA11183 (RI)		10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		RI	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		210998105	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9000154300	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		017673700	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DE	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000230062X	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		060646652001	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100466040A	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200332570E	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1748552	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		009555900	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		157310100	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0452132	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MT	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9700022	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10025481801	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		292866	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0070022	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		071742301	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		009815562	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		060646652	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VI	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0070022	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2077634	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00369686	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0007894900001	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AR	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AR	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		DC	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		DC	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		DE	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		DE	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		ID	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		ID	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		ME	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		ME	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MT	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		MT	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NE	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NE	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NV	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NV	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VI	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VI	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VT	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		VT	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336139500	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WI	10/16/2020 2:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578778726	10/16/2020 2:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WI	10/16/2020 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		092603500	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110066539A	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110066539B	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3104859	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NH	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		14271009	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0369686	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000789490001	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1336V139500	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		YA11183	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10019A	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10242B	9/11/2020 1:55 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336139500	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578778726	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 1:55 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	9/11/2020 1:55 PM
Details	Last Recertification Date	Update	Recertification	9/11/2019 9:36:48 AM	9/11/2020 1:55:53 PM	9/11/2020 1:55 PM
Details	Last Recertification Date	Update	Recertification	9/9/2018 3:29:39 PM	9/11/2019 9:36:48 AM	9/11/2019 9:36 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 2:36:04 PM	9/9/2018 3:29:39 PM	9/9/2018 3:29 PM
Addresses	Main Address	Update	Change Request	1450 Chapel Street New Haven, CT 06511	330 Orchard Street New Haven, CT 06511	7/6/2018 11:17 AM
Addresses	Main Address	Update	Recertification	330 Orchard Street New Haven, CT 06511	1450 Chapel Street New Haven, CT 06511	12/1/2017 2:36 PM
Addresses	Billing Address	Update	Recertification	Yale-New Haven Hospital 20 York Street New Haven, CT 06504	Yale-New Haven Hospital 20 York Street New Haven, CT 06510	12/1/2017 2:36 PM
Details	Last Recertification Date	Update	Recertification	9/5/2016 12:00:00 AM	12/1/2017 2:36:04 PM	12/1/2017 2:36 PM
Contacts	Primary Contact	Update	Change Request	Lee, Lorraine Executive Director, System Pharmacy Services 2036886390	Messina, Mary G Senior Manager, Regulatory Reimbursement Yale New Haven Health System 2036888543	10/13/2017 10:30 AM
Contacts	Authorizing Official	Update		Loftus, Michael Vice President - Finance 2032003833	Loftus, Michael Vice President - Finance Yale New Haven Hospital 2032003833	10/11/2017 1:39 PM
Addresses	Main Address	Insert			330 Orchard Street New Haven, CT 06511	8/11/2017 7:46 AM
Addresses	Billing Address	Insert			Yale-New Haven Hospital 20 York Street New Haven, CT 06504	8/11/2017 7:46 AM
Addresses	Shipping Address	Insert			Yale New Haven Hospital 1450 Chapel Street New Haven, CT 06511-4405	8/11/2017 7:46 AM
Contacts	Signed By	Insert			STATEN, JAMES M. SENIOR VP FINANCE 2036882603	8/11/2017 7:46 AM
Contacts	Primary Contact	Insert			Lee, Lorraine Executive Director, System Pharmacy Services 2036886390	8/11/2017 7:46 AM
Contacts	Authorizing Official	Insert			Loftus, Michael Vice President - Finance 2032003833	8/11/2017 7:46 AM
Medicaid Billing	Medicaid: Number	Update		4025128	004025128	9/5/2016 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/5/2016 10:47 AM
Medicaid Billing	Medicaid: Number	Insert			004041836	9/5/2016 10:47 AM
Medicaid Billing	Medicaid: State	Insert			CT	9/5/2016 10:47 AM
Medicaid Billing	NPI: Number	Insert			1336139500	9/5/2016 10:47 AM
Details	Last Recertification Date	Update		8/28/2015 12:00:00 AM	9/5/2016 12:00:00 AM	9/5/2016 10:47 AM
Details	Entity Subname	Update		Smilow Care Center SRC (HOIT Unit)	HOIT Unit	12/2/2015 11:41 AM
Details	Last Recertification Date	Update		8/22/2014 12:00:00 AM	8/28/2015 12:00:00 AM	8/28/2015 1:46 PM
Details	Last Recertification Date	Update			8/22/2014 12:00:00 AM	8/22/2014 12:08 PM
Dates	Participating Approval Date	Update			5/8/2014 12:00:00 AM	5/8/2014 7:03 AM
Details	State	Update		Pending	Active	5/8/2014 7:03 AM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	5/8/2014 7:03 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH070022AJ	5/1/2014 4:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/12/2014 8:06 AM
Medicaid Billing	Medicaid: Number	Insert			4025128	4/12/2014 8:06 AM
Medicaid Billing	Medicaid: State	Insert			CT	4/12/2014 8:06 AM
Medicaid Billing	NPI: Number	Insert			1578778726	4/12/2014 8:06 AM
Details	Last Recertification Date	Insert				4/12/2014 8:06 AM
Details	Grant Number	Insert				4/12/2014 8:06 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/12/2014 8:06 AM
Details	Is Authorizing Official EHB Data	Insert				4/12/2014 8:06 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/12/2014 8:06 AM
Details	Medicare Provider Number	Insert			070022	4/12/2014 8:06 AM
Details	Entity Name	Insert			YALE NEW HAVEN HOSPITAL	4/12/2014 8:06 AM
Details	Program Code	Insert			DSH	4/12/2014 8:06 AM
Details	Entity Subname	Insert			Smilow Care Center SRC (HOIT Unit)	4/12/2014 8:06 AM
Dates	Participating Approval Date	Insert				4/12/2014 8:06 AM
Details	State	Insert			Pending	4/12/2014 8:06 AM
Dates	Registration Date	Insert			4/12/2014 12:00:00 AM	4/12/2014 8:06 AM
Dates	Signed By Date	Insert			4/12/2014 12:00:00 AM	4/12/2014 8:06 AM
Dates	Start Date	Insert				4/12/2014 8:06 AM
Terminations	Termination Comments	Insert				4/12/2014 8:06 AM
Terminations	Termination Date	Insert				4/12/2014 8:06 AM
Terminations	Termination Effective Date	Insert				4/12/2014 8:06 AM
Terminations	Termination Reason	Insert				4/12/2014 8:06 AM