Covered Entity Details

DSH420051F MCLEOD REGIONAL MEDICAL CENTER (Active) - information as of 5/27/2025 11:33:10 PM

Main Details

Name

MCLEOD REGIONAL MEDICAL CENTER

Subdivision Name

McLeod Hospice House-Hospice of the Pee Dee

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH420051F

Medicare Provider Number

420051

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2014

Participating Start Date

10/1/2014

Participating Approval Date

8/29/2014

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

McLeod Health
Christian Soura, Chief Financial Officer
(843) 777-5492

Primary Contact

McLeod Health
Hattie K. Hyman, PharmD, Pharmacy 340B Manager
(843) 777-5019

Addresses

Street Address

1203 East Cheves Street
Florence, SC 29506

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
SC	420051,GP4675,762735,IC0032,GP2493,GP5292,DPE035,GP2470,GP7618,0384SB,0384VSB,1162,3406854,400514,410022,4200051,42-0057,42-1516,42-3416,42-7057,42-U057,45-9938,47-0573,5819,6245,7234750001,7234750002,C631SB,DE3762,I975,NC,PP0001,RHC525,Q336310001,42-1002,334441,000106202A,01065575,01557551,094184100,100774248-0001,1699756221,262645400,4210301,42-H065,570370242,GP00334,HSP009,NC365	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841,1306123344
NC	420051,0384SB,0384VSB,1162,334441,3406854,400514,410022,42-0057,42-1516,42-3416,42-7057,42-U057,45-9938,47-0573,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP2470,GP2493,GP4675,GP5292,GP7618,I975,IC0032,NC,PP0001,RHC525,Q336310001,42-1002,4200051,000106202A,01065575,01557551,094184100,100774248-0001,1699756221,262645400,4210301,42-H065,570370242,GP00334,HSP009,NC365	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841,1306123344
FL	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
GA	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
MD	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
NJ	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
NY	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
PA	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841
VA	000106202A,01065575,01557551,0384SB,0384VSB,094184100,100774248-0001,1162,1699756221,262645400,334441,3406854,400514,410022,4200051,420051,42-0057,42-1002,4210301,42-1516,42-3416,42-7057,42-H065,42-U057,45-9938,47-0573,570370242,5819,6245,7234750001,7234750002,762735,C631SB,DE3762,DPE035,GP00334,GP2470,GP2493,GP4675,GP5292,GP7618,HSP009,I975,IC0032,NC,NC365,PP0001,Q336310001,RHC525	1043289333,1073594313,1083695621,1154371433,1205882461,1215991682,1285094235,1306123344,1326505728,1376515197,1427004738,1508874488,1518949817,1699756221,1790876902,1801878103,1871775841

Shipping Addresses

Shipping Address 1

McLeod Regional Medical Center
555 EAST CHEVES STREET
Florence, SC 29506

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
DSH420051AA	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Myrtle Beach	107 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051AB	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Seacoast	3793 MCDOWELL LN	LITTLE RIVER	SC	Active
DSH420051AC	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Southern Medical Associates	3418 CASEY ST	LORIS	SC	Active
DSH420051AD	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Regional Medical Center of the Pee Dee Inc d/b/a McLeod Rheumatology Seacoast - McLeod Rheumatology Seacoast	2021 North Myrtle Point Blvd	North Myrtle Beach	SC	Active
DSH420051AE	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Palmetto Adult Medicine	1295 WILSON HALL RD	SUMTER	SC	Active
DSH420051B	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Employee Health Clinic	135 North Ravenel Street	Florence	SC	Terminated
DSH420051C	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	RSV Clinic	101 William H Johnson Street, Suite 400	Florence	SC	Terminated
DSH420051D	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Medical Park East-Chronic Care Management	101 William H Johnson Street, Suite 290	Florence	SC	Terminated
DSH420051E	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Home Health	300 South Dargan Street	Florence	SC	Terminated
DSH420051F	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Hospice House-Hospice of the Pee Dee	1203 East Cheves Street	Florence	SC	Active
DSH420051G	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Tower (Concourse Area)- Radiation Oncology	401 East Cheves Street	Florence	SC	Terminated
DSH420051H	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Tower (Concourse Area)-Infusion Services	401 E. Cheves Street	Florence	SC	Terminated
DSH420051J	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Family Medicine Center	144 North Ravenel Street	Florence	SC	Active
DSH420051K	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Oncology Hematology Associates - Oncology & Hematology	401 East Cheves Street	Florence	SC	Terminated
DSH420051L	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Oncology/Hematology Associates at Seacoast - Oncology/Hematology Clinic	3781 McDowell Lane	Little River	SC	Active
DSH420051M	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	Infusion Services at Seacoast - Outpatient Service	3781 McDowell Lane	Little River	SC	Active
DSH420051N	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MRMC OF THE PEE DEE SURGERY CENTER - Outpatient Surgery	1005 E CHEVES ST	FLORENCE	SC	Active
DSH420051P	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	Main Tower (Concourse Area) - Cancer Center Clinic	401 East Cheves Street	Florence	SC	Terminated
DSH420051Q	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Digestive Health Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051R	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051S	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Carolina Forest 2	107 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051T	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Carolina Forest 1	101 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051U	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Regional Medical Center of the Pee Dee Inc d/b/a McLeod Plaza Family Medicine - McLeod Medical Plaza Family Practice	800 East Cheves Street	Florence	SC	Active
DSH420051V	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Family Medicine South	611 2ND LOOP RD	FLORENCE	SC	Active
DSH420051W	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Jeter & Skinner Family Practice	800 E CHEVES ST	FLORENCE	SC	Active
DSH420051X	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Neurological Associates Florence	800 E CHEVES ST	FLORENCE	SC	Active
DSH420051Y	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Neurology Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051Z	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Loris	3485 MITCHELL ST	LORIS	SC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	Soura, Christian Chief Financial Officer McLeod Health 8437775492	3/28/2025 7:19 AM
Details	Last Recertification Date	Update	Recertification	9/1/2023 1:34:06 PM	9/4/2024 3:13:37 PM	9/4/2024 3:13 PM
Contacts	Primary Contact	Update	Profile Change Request	Hyman, PharmD, Hattie K. 340B Manager McLeod Health 8437772165	Hyman, PharmD, Hattie K. Pharmacy 340B Manager McLeod Health 8437775019	1/16/2024 5:19 PM
Contacts	Primary Contact	Update	Profile Change Request	Hyman, PharmD, Hattie K. Pharmacy Compliance Officer McLeod Regional Medical Center 8437772165	Hyman, PharmD, Hattie K. 340B Manager McLeod Health 8437772165	10/17/2023 7:34 AM
Contacts	Authorizing Official	Update	Profile Change Request	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Regional Medical Center 8437772848	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	9/5/2023 6:27 AM
Contacts	Signed By	Update	Profile Change Request	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Regional Medical Center 8437772848	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	9/5/2023 6:27 AM
Details	Last Recertification Date	Update	Recertification	9/13/2022 3:00:52 PM	9/1/2023 1:34:06 PM	9/1/2023 1:34 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 11:13:30 AM	9/13/2022 3:00:52 PM	9/13/2022 3:00 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	42-S057 (SC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	AB0008 (SC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	GP0334 (SC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	HSP0009 (SC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	42-S057 (NC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	AB0008 (NC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	GP0334 (NC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	HSP0009 (NC)		9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000106202A	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01065575	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01557551	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		094184100	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100774248-0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		262645400	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		420051	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4210301	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-H065	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		570370242	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP00334	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP009	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC365	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306123344	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/7/2021 11:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/7/2021 11:13 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 12:38:48 PM	9/7/2021 11:13:30 AM	9/7/2021 11:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	459938 (SC)		9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	HSP009 (SC)		9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	GP7618 (SC)		9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		4200051	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-S057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		AB0008	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP0334	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP0009	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384SB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0384VSB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1162	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		334441	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3406854	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		400514	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		410022	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-0057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1516	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-3416	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-7057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-S057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-U057	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		45-9938	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		47-0573	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5819	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		6245	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7234750002	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		762735	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		AB0008	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		C631SB	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DE3762	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		DPE035	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP0334	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2470	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP2493	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4675	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP5292	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP7618	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HSP0009	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		I975	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		IC0032	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		PP0001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		RHC525	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q336310001	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		42-1002	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1043289333 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1508874488 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1871775841 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1154371433 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1205882461 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1427004738 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1699756221 ( )		9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043289333	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073594313	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083695621	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154371433	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205882461	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215991682	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285094235	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326505728	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1376515197	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427004738	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508874488	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518949817	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1699756221	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790876902	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801878103	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871775841	9/3/2020 12:38 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/3/2020 12:38 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 11:04:03 AM	9/3/2020 12:38:48 PM	9/3/2020 12:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		420051	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		420051	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		459938	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		HSP009	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP4675	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		762735	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP7618	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		IC0032	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP2493	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP5292	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		DPE035	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP2470	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		GP7618	10/10/2019 1:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043289333	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1508874488	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871775841	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1154371433	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1205882461	10/10/2019 1:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1427004738	10/10/2019 1:08 PM
Details	Last Recertification Date	Update	Recertification	8/31/2018 8:07:22 AM	9/13/2019 11:04:03 AM	9/13/2019 11:04 AM
Contacts	Primary Contact	Update	Profile Change Request	Hyman, Pharm.D, Hattie K. Pharmacy Compliance Officer McLeod Regional Medical Center 8437772165	Hyman, PharmD, Hattie K. Pharmacy Compliance Officer McLeod Regional Medical Center 8437772165	9/17/2018 3:13 PM
Addresses	Shipping Address	Insert	Recertification		McLeod Regional Medical Center 555 EAST CHEVES STREET Florence, SC 29506	8/31/2018 8:07 AM
Addresses	Shipping Address	Delete	Recertification	McLeod Regional Medical Center 555 EAST CHEVES STREET Florence, SC 29501		8/31/2018 8:07 AM
Contacts	Primary Contact	Update	Recertification	Clay, Deronda Dru AVP Business Office Services DSH Hospital 8436108494	Hyman, Pharm.D, Hattie K. Pharmacy Compliance Officer McLeod Regional Medical Center 8437772165	8/31/2018 8:07 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 2:39:26 PM	8/31/2018 8:07:22 AM	8/31/2018 8:07 AM
Contacts	Authorizing Official	Update	Profile Change Request	ERVIN, FULTON CFO McLeod Regional Medical Center 8437772910	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Regional Medical Center 8437772848	8/30/2018 4:10 PM
Contacts	Signed By	Update	Profile Change Request	ERVIN, FULTON CFO McLeod Regional Medical Center 8437772910	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Regional Medical Center 8437772848	8/30/2018 4:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Clay, Deronda Dru AVP Finance Analytics/Optimization DSH Hospital 8436108494	Clay, Deronda Dru AVP Business Office Services DSH Hospital 8436108494	8/19/2018 9:45 PM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	11/15/2017 2:39:26 PM	11/15/2017 2:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Clay, Deronda Dru Business Manager DSH Hospital 8436108494	Clay, Deronda Dru AVP Finance Analytics/Optimization DSH Hospital 8436108494	10/5/2017 11:45 AM
Contacts	Authorizing Official	Update	New Registration	ERVIN, FULTON CFO 8437772910	ERVIN, FULTON CFO McLeod Regional Medical Center 8437772910	10/5/2017 11:41 AM
Contacts	Signed By	Update	New Registration	ERVIN, FULTON CFO 8437772910	ERVIN, FULTON CFO McLeod Regional Medical Center 8437772910	10/5/2017 11:41 AM
Contacts	Primary Contact	Update	New Registration	Clay, Deronda Business Manager DSH Hospital 8436108494	Clay, Deronda Dru Business Manager DSH Hospital 8436108494	10/5/2017 11:41 AM
Contacts	Primary Contact	Update		Clay, Deronda Business Manager 8436108494	Clay, Deronda Business Manager DSH Hospital 8436108494	10/3/2017 9:02 AM
Contacts	Authorizing Official	Insert			ERVIN, FULTON CFO 8437772910	1/30/2017 8:54 AM
Contacts	Signed By	Insert			ERVIN, FULTON CFO 8437772910	1/30/2017 8:54 AM
Contacts	Primary Contact	Insert			Clay, Deronda Business Manager 8436108494	1/30/2017 8:54 AM
Addresses	Main Address	Insert			1203 East Cheves Street Florence, SC 29506	8/24/2016 1:24 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/24/2016 12:00:00 AM	8/24/2016 1:24 PM
Addresses	Shipping Address	Insert			McLeod Regional Medical Center 555 EAST CHEVES STREET Florence, SC 29501	3/21/2016 9:18 AM
Details	Last Recertification Date	Update			8/7/2015 12:00:00 AM	8/7/2015 11:33 AM
Details	Entity Subname	Update		McLeod Hospice House-Hospice of the Pee Dee / Hospice of the Pee Dee	McLeod Hospice House-Hospice of the Pee Dee	12/31/2014 3:51 PM
Details	Entity Subname	Update		McLeod Hospice House-Hospice of the Pee Dee	McLeod Hospice House-Hospice of the Pee Dee / Hospice of the Pee Dee	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			8/29/2014 12:00:00 AM	8/29/2014 2:23 PM
Details	State	Update		Pending	Active	8/29/2014 2:23 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	8/29/2014 2:23 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45812	DSH420051F	8/25/2014 1:23 PM
Details	Entity Subname	Update		Hospice of the Pee Dee	McLeod Hospice House-Hospice of the Pee Dee	8/25/2014 1:23 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45812	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: Number	Insert			334441	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: State	Insert			SC	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: Number	Insert			4200051	7/15/2014 5:12 AM
Medicaid Billing	Medicaid: State	Insert			NC	7/15/2014 5:12 AM
Medicaid Billing	NPI: Number	Insert			1699756221	7/15/2014 5:12 AM
Details	Last Recertification Date	Insert				7/15/2014 5:12 AM
Details	Grant Number	Insert				7/15/2014 5:12 AM
Details	340B ID	Insert				7/15/2014 5:12 AM
Details	Is Authorizing Official EHB Data	Insert				7/15/2014 5:12 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2014 5:12 AM
Details	Medicare Provider Number	Insert			420051	7/15/2014 5:12 AM
Details	Entity Name	Insert			MCLEOD REGIONAL MEDICAL CENTER	7/15/2014 5:12 AM
Details	Program Code	Insert			DSH	7/15/2014 5:12 AM
Details	Entity Subname	Insert			Hospice of the Pee Dee	7/15/2014 5:12 AM
Dates	Participating Approval Date	Insert				7/15/2014 5:12 AM
Details	State	Insert			Pending	7/15/2014 5:12 AM
Dates	Registration Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 5:12 AM
Dates	Signed By Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 5:12 AM
Dates	Start Date	Insert				7/15/2014 5:12 AM
Terminations	Termination Comments	Insert				7/15/2014 5:12 AM
Terminations	Termination Date	Insert				7/15/2014 5:12 AM
Terminations	Termination Effective Date	Insert				7/15/2014 5:12 AM
Terminations	Termination Reason	Insert				7/15/2014 5:12 AM