340B Drug Pricing Program Database


DSH100088U BAPTIST MEDICAL CENTER (Active) - information as of 4/25/2025 12:00:59 AM

Main Details
BAPTIST MEDICAL CENTER
MOB-Cardiology/Nuc Med CLY
Disproportionate Share Hospital
Yes
DSH100088U
100088


Additional Details
Active
7/14/2014
4/1/2017
9/3/2014
8/26/2024

Contacts

Baptist Medical Center
Scott Finnegan, Senior Vice President of Finance/Treasury
(904) 202-3270

Baptist Medical Center
Pamela Michelle Johnston, Sr 340B Pharmacy Specialist
(904) 202-5255

Addresses

1771 Baptist Clay Drive
Fleming Island, FL 32003

Baptist Medical Center
PO BOX 45128
Jacksonville, FL 32232


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participating Date (10/01/2014) until terminated effective date ( 07/01/2015), Reinstatement date ( 04/01/2017)03/15/2017
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL0100641031578620449,1316112014,1457526154,1972044857,1174297626
GA 1578620449,1316112014,1457526154,1972044857,1174297626
AL 1578620449,1316112014,1457526154,1972044857,1174297626
MS 1578620449,1316112014,1457526154,1972044857,1174297626
SC 1578620449,1316112014,1457526154,1972044857,1174297626
Shipping Addresses

Baptist Medical Center
800 Prudential Dr
Jacksonville, FL 32207

Baptist Medical Center Clay
1771 Baptist Clay Dr
Fleming Island, FL 32003
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH100088AChildDSHBAPTIST MEDICAL CENTERBAPTIST MEDICAL CENTER SOUTH14550 OLD ST AUGUSTINE RDJACKSONVILLEFLActive
DSH100088AAChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Endoscopy14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088ABChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Emergency Services14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088ACChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Recovery Services14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088ADChildDSHBAPTIST MEDICAL CENTERSouth MOB ll-O/P Surgery Center14540 Old St. Augustine RdJacksonvilleFLTerminated
DSH100088AEChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Surgical Services14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088AFChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-MRI14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088AGChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Special Procedures14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088AHChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Nuclear Medicine14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088AJChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Radiology14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088AKChildDSHBAPTIST MEDICAL CENTERCardiology/Nuc Med South- Baptist Heart14534 Old St. Augustine RdJacksonvilleFLActive
DSH100088ALChildDSHBAPTIST MEDICAL CENTERBMDACC Infusion Center1301 Palm AveJacksonvilleFLActive
DSH100088AMChildDSHBAPTIST MEDICAL CENTERCardiology Pavilion- Baptist Heart836 Prudential DrJacksonvilleFLActive
DSH100088ANChildDSHBAPTIST MEDICAL CENTERCardiac Nuc Med University- Baptist Heart3225 University Blvd SJacksonvilleFLActive
DSH100088APChildDSHBAPTIST MEDICAL CENTERCardiac Nuc Med- Pavilion Baptist Heart836 Prudential DrJacksonvilleFLActive
DSH100088AQChildDSHBAPTIST MEDICAL CENTERCardiology Howard SHG820 Prudential DrJacksonvilleFLTerminated
DSH100088ARChildDSHBAPTIST MEDICAL CENTERBAPTIST EMERGENCY CENTER AT CLAY1771 BAPTIST CLAY RDFLEMING ISLANDFLActive
DSH100088ASChildDSHBAPTIST MEDICAL CENTERBaptist Emergency at Town Center4085 Town Center ParkwayJacksonvilleFLActive
DSH100088ATChildDSHBAPTIST MEDICAL CENTERBaptist Emergency at North11250 Baptist Health DriveJacksonvilleFLActive
DSH100088AUChildDSHBAPTIST MEDICAL CENTERBaptist Jacksonville Infusion Services1235 San Marco BlvdJacksonvilleFLActive
DSH100088AVChildDSHBAPTIST MEDICAL CENTERBMDA South Infusion Center14546 Old St Augustine RdJacksonvilleFLActive
DSH100088AWChildDSHBAPTIST MEDICAL CENTERWCH Infusion Center at Nemours - Infusion807 Childrens WayJacksonvilleFLActive
DSH100088AXChildDSHBAPTIST MEDICAL CENTERBAPTIST CLAY- Surgical Services1771 BAPTIST CLAY DRFLEMING ISLANDFLActive
DSH100088AYChildDSHBAPTIST MEDICAL CENTERBAPTIST OAKLEAF - Emergency Center9868 FAMILY PLACEJACKSONVILLEFLActive
DSH100088AZChildDSHBAPTIST MEDICAL CENTERHead/Neck Surgery - BMDA1301 Palm AveJacksonvilleFLTerminated
DSH100088BChildDSHBAPTIST MEDICAL CENTERBAPTIST HOME HEALTH CARE3563 PHILIPS HIGHWAYJACKSONVILLEFLTerminated
DSH100088BAChildDSHBAPTIST MEDICAL CENTERColorectal GI Surgery - BMDA1301 Palm AveJacksonvilleFLTerminated
DSH100088BBChildDSHBAPTIST MEDICAL CENTEROrthopedic Surgery - BMDA1301 Palm AveJacksonvilleFLTerminated
DSH100088BCChildDSHBAPTIST MEDICAL CENTERSurgical Oncology - BMDA1301 Palm AveJacksonvilleFLActive
DSH100088BDChildDSHBAPTIST MEDICAL CENTERThoracic Surgery - BMDA1301 Palm AveJacksonvilleFLTerminated
DSH100088BEChildDSHBAPTIST MEDICAL CENTERUrology Oncology Surgery - BMDA1301 Palm AveJacksonvilleFLTerminated
DSH100088BFChildDSHBAPTIST MEDICAL CENTERBaptist Clay- Heart Center - Baptist Heart2310 Village Square Parkway Suite 104Fleming IslandFLActive
DSH100088BGChildDSHBAPTIST MEDICAL CENTERBaptist Clay- MRI - MRI1771 Baptist Clay DrFleming IslandFLActive
DSH100088BHChildDSHBAPTIST MEDICAL CENTERBaptist Clay- Mammography - Mammography2310 Village Square Parkway Suite 104Fleming IslandFLActive
DSH100088BJChildDSHBAPTIST MEDICAL CENTERBaptist Clay- Recovery Services - Recovery1771 Baptist Clay DrFleming IslandFLActive
DSH100088BKChildDSHBAPTIST MEDICAL CENTERBaptist Clay- Endoscopy - Endoscopy1771 Baptist Clay DrFleming IslandFLActive
DSH100088BLChildDSHBAPTIST MEDICAL CENTERBMDA Clay- Radiation Therapy - Radiation2310 Village Square ParkwayFleming IslandFLActive
DSH100088BMChildDSHBAPTIST MEDICAL CENTERBMDA Clay- Infusion Center - Infusion2310 Village Square ParkwayFleming IslandFLActive
DSH100088BNChildDSHBAPTIST MEDICAL CENTERBAPTIST CLAY - Medical Surgical services/Observation1771 BAPTIST CLAY DRFLEMING ISLANDFLActive
DSH100088BPChildDSHBAPTIST MEDICAL CENTERBaptist Emergency- St Augustine - Emergency461 Outlet Mall BlvdSt AugustineFLApproved
DSH100088CChildDSHBAPTIST MEDICAL CENTERBAPTIST OUTPATIENT CENTER OR1235 SAN MARCO BOULEVARDJACKSONVILLEFLTerminated
DSH100088DChildDSHBAPTIST MEDICAL CENTERREID MEDICAL BUILDING1325 SAN MARCO BOULEVARDJACKSONVILLEFLTerminated
DSH100088EChildDSHBAPTIST MEDICAL CENTERCHILDREN'S CARDIOLOGY CENTER841 Prudential DriveJACKSONVILLEFLActive
DSH100088FChildDSHBAPTIST MEDICAL CENTERAgeWell Institute841 Prudential DriveJacksonvilleFLTerminated
DSH100088GChildDSHBAPTIST MEDICAL CENTERCardiology University- Baptist Heart3225 University Blvd. S.JacksonvilleFLActive
DSH100088HChildDSHBAPTIST MEDICAL CENTERCardiac Nuc Med Howard SHG820 Prudential DrJacksonvilleFLTerminated
DSH100088JChildDSHBAPTIST MEDICAL CENTERBMDA-Medical & Surgical Oncology Breast/GYN1301 Palm AveJacksonvilleFLTerminated
DSH100088KChildDSHBAPTIST MEDICAL CENTERBMDACC-Radiation Therapy1301 Palm AveJacksonvilleFLActive
DSH100088LChildDSHBAPTIST MEDICAL CENTERBMDACC- Imaging Services1301 Palm AveJacksonvilleFLActive
DSH100088MChildDSHBAPTIST MEDICAL CENTEROutpatient Center-Breast Center1235 San Marco BlvdJacksonvilleFLActive
DSH100088NChildDSHBAPTIST MEDICAL CENTERJOI/Reid Building- MRI 1325 San Marco BlvdJacksonvilleFLTerminated
DSH100088PChildDSHBAPTIST MEDICAL CENTERJOI/Reid Building-OR1325 San Marco BlvdJacksonvilleFLActive
DSH100088QChildDSHBAPTIST MEDICAL CENTERWCH Outpatient Surgery836 Prudential DrJacksonvilleFLActive
DSH100088RChildDSHBAPTIST MEDICAL CENTERImaging Center Building-Mammography1771 Baptist Clay DriveFleming IslandFLTerminated
DSH100088SChildDSHBAPTIST MEDICAL CENTERImaging Center Building-Cat Scan1771 Baptist Clay DriveFleming IslandFLTerminated
DSH100088TChildDSHBAPTIST MEDICAL CENTERBaptist Clay-Diagnostic Radiology1771 Baptist Clay DriveFleming IslandFLActive
DSH100088UChildDSHBAPTIST MEDICAL CENTERMOB-Cardiology/Nuc Med CLY1771 Baptist Clay DriveFleming IslandFLActive
DSH100088VChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Cath Lab14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088WChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-CardioPulmonary14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088XChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Anesthesia14550 Old St. Augustine RdJacksonvilleFLActive
DSH100088YChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-Radiation Therapy14546 Old St. Augustine RdJacksonvilleFLActive
DSH100088ZChildDSHBAPTIST MEDICAL CENTERBaptist Medical Center South-O/P Diagnostic Imaging14534 Old St. Augustine RdJacksonvilleFLActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/24/2023 9:24:12 AM8/26/2024 8:39:23 AM8/26/2024 8:39 AM
DetailsLast Recertification DateUpdateRecertification9/8/2022 1:00:03 PM8/24/2023 9:24:12 AM8/24/2023 9:24 AM
AddressesShipping AddressInsertGroup Change Request Baptist Medical Center Clay 1771 Baptist Clay Dr Fleming Island, FL 3200311/15/2022 11:01 AM
DetailsLast Recertification DateUpdateRecertification8/30/2021 7:22:21 AM9/8/2022 1:00:03 PM9/8/2022 1:00 PM
AddressesBilling AddressUpdateGroup Change RequestBaptist Medical Center PO Box 45094 Jacksonville, FL 32232Baptist Medical Center PO BOX 45128 Jacksonville, FL 322324/16/2022 5:05 PM
ContactsAuthorizing OfficialUpdateChange RequestWooten, Scott M. SVP & CFO Baptist Medical Center 9042023405Finnegan, Scott Senior Vice President of Finance/Treasury Baptist Medical Center 90420232701/7/2022 11:49 AM
ContactsPrimary ContactUpdateProfile Change RequestJohnston, Pamela Michelle Financial Analyst I Baptist Medical Center 9042025255Johnston, Pamela Michelle Sr 340B Pharmacy Specialist Baptist Medical Center 90420252551/6/2022 10:35 AM
Medicaid BillingNPI: NumberInsertChange Request 117429762610/27/2021 9:18 AM
Medicaid BillingNPI: StateInsertChange Request FL10/27/2021 9:18 AM
Medicaid BillingNPI: NumberInsertChange Request 117429762610/27/2021 9:18 AM
Medicaid BillingNPI: StateInsertChange Request GA10/27/2021 9:18 AM
Medicaid BillingNPI: NumberInsertChange Request 117429762610/27/2021 9:18 AM
Medicaid BillingNPI: StateInsertChange Request AL10/27/2021 9:18 AM
Medicaid BillingNPI: NumberInsertChange Request 117429762610/27/2021 9:18 AM
Medicaid BillingNPI: StateInsertChange Request MS10/27/2021 9:18 AM
Medicaid BillingNPI: NumberInsertChange Request 117429762610/27/2021 9:18 AM
Medicaid BillingNPI: StateInsertChange Request SC10/27/2021 9:18 AM
DetailsLast Recertification DateUpdateRecertification8/28/2020 1:31:23 PM8/30/2021 7:22:21 AM8/30/2021 7:22 AM
Medicaid BillingNPI: NumberInsertRecertification 13161120148/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 14575261548/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19720448578/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15786204498/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification GA8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 13161120148/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification GA8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 14575261548/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification GA8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19720448578/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification GA8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15786204498/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification AL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 13161120148/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification AL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 14575261548/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification AL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19720448578/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification AL8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15786204498/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification MS8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 13161120148/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification MS8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 14575261548/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification MS8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19720448578/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification MS8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15786204498/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification SC8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 13161120148/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification SC8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 14575261548/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification SC8/28/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19720448578/28/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification SC8/28/2020 1:31 PM
Medicaid BillingNPI: StateUpdateRecertification FL8/28/2020 1:31 PM
DetailsLast Recertification DateUpdateRecertification9/6/2019 8:33:27 AM8/28/2020 1:31:23 PM8/28/2020 1:31 PM
DetailsLast Recertification DateUpdateRecertification8/15/2018 10:08:47 AM9/6/2019 8:33:27 AM9/6/2019 8:33 AM
AddressesShipping AddressInsertChange Request Baptist Medical Center 800 Prudential Dr Jacksonville, FL 322076/27/2019 9:43 AM
AddressesBilling AddressInsertChange Request Baptist Medical Center PO Box 45094 Jacksonville, FL 322329/18/2018 11:22 AM
Medicaid BillingMedicaid: NumberDeleteChange Request010064100 (FL) 9/18/2018 11:22 AM
DetailsLast Recertification DateUpdateRecertification11/6/2017 10:09:20 AM8/15/2018 10:08:47 AM8/15/2018 10:08 AM
DetailsLast Recertification DateUpdateRecertification 11/6/2017 10:09:20 AM11/6/2017 10:09 AM
Medicaid BillingMedicaid: NumberUpdateChange Request0100641-0301006410310/9/2017 2:44 PM
Medicaid BillingNPI: NumberInsertChange Request 157862044910/9/2017 2:44 PM
ContactsAuthorizing OfficialUpdate Wooten, Scott M. SVP & CFO 9042023405Wooten, Scott M. SVP & CFO Baptist Medical Center 90420234059/22/2017 11:37 AM
ContactsSigned ByUpdate Wooten, Scott M. SVP & CFO 9042023405Wooten, Scott M. SVP & CFO Baptist Medical Center 90420234059/22/2017 11:37 AM
ContactsPrimary ContactUpdate Johnston, Pamela Financial Analyst I 9042025255Johnston, Pamela Michelle Financial Analyst I Baptist Medical Center 90420252559/20/2017 12:26 PM
ContactsAuthorizing OfficialInsert  Wooten, Scott M. SVP & CFO 90420234058/11/2017 1:55 PM
ContactsSigned ByInsert  Wooten, Scott M. SVP & CFO 90420234058/11/2017 1:55 PM
ContactsPrimary ContactInsert  Johnston, Pamela Financial Analyst I 90420252554/25/2017 1:58 PM
AddressesMain AddressInsert   1771 Baptist Clay Drive Fleming Island, FL 320034/25/2017 1:58 PM
DatesStart DateUpdate 7/1/2017 12:00:00 AM4/1/2017 12:00:00 AM3/15/2017 6:46 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/15/2017 1:59 PM
Medicaid BillingMedicaid: NumberInsert  0100641-033/15/2017 1:59 PM
Medicaid BillingMedicaid: StateInsert  FL3/15/2017 1:59 PM
DatesLast Date That 340B Drugs PurchasedUpdate 10/1/2014 12:00:00 AM 3/15/2017 1:55 PM
DetailsStateUpdate TerminatedActive3/15/2017 1:55 PM
DatesStart DateUpdate 10/1/2014 12:00:00 AM7/1/2017 12:00:00 AM3/15/2017 1:55 PM
TerminationsTermination CommentsUpdate Hospital unable to set up system to order 340B drugs at this site, 340B was never purchased/used/ordered. 3/15/2017 1:55 PM
TerminationsTermination DateUpdate 7/1/2015 12:00:00 AM 3/15/2017 1:55 PM
TerminationsTermination Effective DateUpdate 4/1/2015 12:00:00 AM 3/15/2017 1:55 PM
TerminationsTermination ReasonUpdate Other 3/15/2017 1:55 PM
DetailsComments PublicInsert  Participating Date (10/01/2014) until terminated effective date ( 07/01/2015), Reinstatement date ( 04/01/2017)3/15/2017 1:55 PM
DatesLast Date That 340B Drugs PurchasedUpdate  10/1/2014 12:00:00 AM4/2/2015 8:28 AM
DetailsStateUpdate ActiveTerminated4/2/2015 8:28 AM
TerminationsTermination CommentsUpdate  Hospital unable to set up system to order 340B drugs at this site, 340B was never purchased/used/ordered.4/2/2015 8:28 AM
TerminationsTermination DateUpdate  7/1/2015 12:00:00 AM4/2/2015 8:28 AM
TerminationsTermination Effective DateUpdate  4/1/2015 12:00:00 AM4/2/2015 8:28 AM
TerminationsTermination ReasonUpdate  Other4/2/2015 8:28 AM
DetailsEntity SubnameUpdate MOB-Cardiology/Nuc Med CLY / Cardiology/Nuc Med CLYMOB-Cardiology/Nuc Med CLY12/31/2014 3:51 PM
DetailsEntity SubnameUpdate MOB-Cardiology/Nuc Med CLYMOB-Cardiology/Nuc Med CLY / Cardiology/Nuc Med CLY12/19/2014 2:16 PM
DatesParticipating Approval DateUpdate  9/3/2014 12:00:00 AM9/3/2014 10:16 AM
DetailsStateUpdate PendingActive9/3/2014 10:16 AM
DatesStart DateUpdate  10/1/2014 12:00:00 AM9/3/2014 10:16 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_45774DSH100088U8/29/2014 11:15 AM
DetailsEntity SubnameUpdate Cardiology/Nuc Med CLYMOB-Cardiology/Nuc Med CLY8/29/2014 11:03 AM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_457747/14/2014 10:34 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/14/2014 10:34 PM
Medicaid BillingMedicaid: NumberInsert  0100641007/14/2014 10:34 PM
Medicaid BillingMedicaid: StateInsert  FL7/14/2014 10:34 PM
DetailsLast Recertification DateInsert   7/14/2014 10:34 PM
DetailsGrant NumberInsert   7/14/2014 10:34 PM
Details340B IDInsert   7/14/2014 10:34 PM
DetailsIs Authorizing Official EHB DataInsert   7/14/2014 10:34 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/14/2014 10:34 PM
DetailsMedicare Provider NumberInsert  1000887/14/2014 10:34 PM
DetailsEntity NameInsert  BAPTIST MEDICAL CENTER7/14/2014 10:34 PM
DetailsProgram CodeInsert  DSH7/14/2014 10:34 PM
DetailsEntity SubnameInsert  Cardiology/Nuc Med CLY7/14/2014 10:34 PM
DatesParticipating Approval DateInsert   7/14/2014 10:34 PM
DetailsStateInsert  Pending7/14/2014 10:34 PM
DatesRegistration DateInsert  7/14/2014 12:00:00 AM7/14/2014 10:34 PM
DatesSigned By DateInsert  7/14/2014 12:00:00 AM7/14/2014 10:34 PM
DatesStart DateInsert   7/14/2014 10:34 PM
TerminationsTermination CommentsInsert   7/14/2014 10:34 PM
TerminationsTermination DateInsert   7/14/2014 10:34 PM
TerminationsTermination Effective DateInsert   7/14/2014 10:34 PM
TerminationsTermination ReasonInsert   7/14/2014 10:34 PM