340B Drug Pricing Program Database


CHC26566-09 JANE PAULEY COMMUNITY HEALTH CENTER, INC. (Active) - information as of 4/29/2025 11:51:10 PM

Main Details
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Jane Pauley Community Health Center at Greenfield
HRSA-Funded Health Center
BPS-H80-013886
CHC26566-09
H80CS26566


Additional Details
Active
1/13/2015
4/1/2015
1/22/2015
2/10/2025

Contacts

Jane Pauley Community Health Center
Aaron Knapp, Dir of Pharmacy Operations
(812) 632-0917

Jane Pauley Community Health Center
Dale Marion, 340B Program Manager
(317) 552-0690

Addresses

1107 N STATE ST
GREENFIELD, IN 46140-1207

Jane Pauley Community Health Center, Inc.
1503 N. Mitthoeffer Rd.
Indianapolis, IN 46229


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IN201026910K1730488818
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailWALGREEN CO.DBA: WALGREENS # 07174 1195 N STATE STREET
GREENFIELDIN46140-120701/09/202404/01/2024  04/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC26566-00ActiveBPS-H80-013290JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center8931 E. 30th Street IndianapolisIN
CHC26566-01TerminatedBPS-H80-013110JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Center at Howe4900 Julian Ave IndianapolisIN
CHC26566-02TerminatedBPS-H80-013082JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center Dental Clinic9651 E 21st St IndianapolisIN
CHC26566-03TerminatedBPS-H80-013109JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Center at Hawthorne Elementary8301 Rawles Ave IndianapolisIN
CHC26566-04TerminatedBPS-H80-013301JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Brook Park5259 David St IndianapolisIN
CHC26566-05TerminatedBPS-H80-013269JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Center at Shelbyville1200 W Mckay Rd ShelbyvilleIN
CHC26566-06ActiveBPS-H80-013254JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Center at Shadeland2040 N Shadeland Ave STE 300 IndianapolisIN
CHC26566-07TerminatedBPS-H80-013938JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Gallahue5470 E 16TH ST INDIANAPOLISIN
CHC26566-08ActiveBPS-H80-013890JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Anderson1210 Medical Arts Boulevard, Suite 300 AndersonIN
CHC26566-09ActiveBPS-H80-013886JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Greenfield1107 N STATE ST GREENFIELDIN
CHC26566-10ActiveBPS-H80-013885JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at 16th Street5317 E 16TH ST INDIANAPOLISIN
CHC26566-11ActiveBPS-H80-013533JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center Administraive Offices1503 N MITTHOEFFER RD INDIANAPOLISIN
CHC26566-12TerminatedBPS-H80-017046JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Madison Avenue8320 Madison Avenue IndianapolisIN
CHC26566-13ActiveBPS-H80-017652JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at the Wigwam1229 Lincoln Street AndersonIN
CHC26566-14TerminatedBPS-H80-017651JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Ebbertt325 W. 38th Street AndersonIN
CHC26566-15ActiveBPS-H80-017650JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Alexandria121 W. Washington Street AlexandriaIN
CHC26566-16ActiveBPS-H80-036469JANE PAULEY COMMUNITY HEALTH CENTER, INC.Jane Pauley Community Health Center at Shelbyville IN 441818 E. State Road 44, Suite B ShelbyvilleIN
CHC26566-17ActiveBPS-H80-021296Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Arlington1315 N Arlington Ave IndianapolisIN
CHC26566-18TerminatedBPS-H80-020788Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Holy Cross South Campus School2825 Lincoln Street Resource Room AndersonIN
CHC26566-19TerminatedBPS-H80-020791Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at St. Mary School820 West Madison Avenue Zimmerman Hall AlexandriaIN
CHC26566-20TerminatedBPS-H80-020789Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Holy Cross North Campus School1115 Pearl Street Room 209 AndersonIN
CHC26566-21ActiveBPS-H80-020787Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Alexandria-Monroe Junior-Senior High School1 Burden Court Room #16 AlexandriaIN
CHC26566-22ActiveBPS-H80-020911Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Alexandria-Monroe Intermediate School308 W. 11th Street Room G-1 AlexandriaIN
CHC26566-23ActiveBPS-H80-022278Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Castleton7481 N. Shadeland Avenue, Suite A IndianapolisIN
CHC26566-24TerminatedBPS-H80-024639Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Smith Valley Road1664 Smith Valley Road GreenwoodIN
CHC26566-25ActiveBPS-H80-035627JANE PAULEY COMMUNITY HEALTH CENTER INCJane Pauley Community Health Center Administrative Site at Arlington1311 N Arlington Avenue IndianapolisIN
CHC26566-26ActiveBPS-H80-038314Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Washington Street7910 E Washington St, Ste 300 IndianapolisIN
CHC26566-27ActiveBPS-H80-038278Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at Reed Street Kokomo3611 S Reed Rd KokomoIN
CHC26566-28ActiveBPS-H80-038262Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at 1629 Anderson1629 Medical Arts Blvd AndersonIN
CHC26566-29ActiveBPS-H80-038277Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at County Line Road Greenwood333 E County Line Rd GreenwoodIN
CHC26566-30ToBeTerminatedBPS-H80-038276Jane Pauley Community Health Center, Inc.Jane Pauley Community Health Center at LaFountain Street Kokomo3510 S Lafountain St KokomoIN
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC26566-00ACARIAHEALTH PHARMACY #26, INC8715 HENDERSON RD
TAMPAFL3363407/01/2024 11/01/2024
CHC26566-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/01/2024  
CHC26566-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/01/2024  
CHC26566-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/01/2024  
CHC26566-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/01/2024  
CHC26566-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/01/2024  
CHC26566-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/01/2024  
CHC26566-00BIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005804/01/2024  
CHC26566-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC26566-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC26566-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CHC26566-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/01/2025  
CHC26566-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
CHC26566-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2022  
CHC26566-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2022  
CHC26566-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2022  
CHC26566-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2022  
CHC26566-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2022  
CHC26566-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2022  
CHC26566-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2022  
CHC26566-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2022  
CHC26566-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2022  
CHC26566-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2022  
CHC26566-00CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506907/01/2024  
CHC26566-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2023  
CHC26566-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2023  
CHC26566-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2022  
CHC26566-00CYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/01/2023 01/01/2023
CHC26566-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/01/2023  
CHC26566-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/01/2024  
CHC26566-00EAST SIDE PRESCRIPTION SHOP5317 EAST 16TH STREET
INDIANAPOLISIN4621804/01/2018 07/31/2019
CHC26566-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/01/2024  
CHC26566-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/01/2024  
CHC26566-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/01/2024  
CHC26566-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/01/2024  
CHC26566-00FOUNDATION CARE LLC111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELDMO6300507/01/2024  
CHC26566-00GENOA HEALTHCARE LLC2009 BROWN STREET SUITE 7
ANDERSONIN46016-421601/01/2024  
CHC26566-00GENOA HEALTHCARE LLC6655 EAST US HIGHWAY 36
AVONIN4612301/01/2024  
CHC26566-00GENOA HEALTHCARE LLC5470 E 16TH STREET SUITE 150
INDIANAPOLISIN4621810/01/2024  
CHC26566-00GEORGE'S PHARMACY EAST SIDE, LLC5543 E WASHINGTON ST
INDIANAPOLISIN4621907/01/2021  
CHC26566-00HOMESCRIPTS12968 PAULINE DR
SHELBY TOWNSHIPMI4831507/01/2024  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06613 4401 E. 10TH ST.
INDIANAPOLISIN4620104/01/2018  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 08643 1030 N ARLINGTON AVE
INDIANAPOLISIN4621904/01/2018  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 00045 6975 N. PENDLETON PIKE
INDIANAPOLISIN4622601/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 04633 1233 NORTH STATE ST.
GREENFIELDIN4614001/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 05423 7935 BROOKVILLE RD.
INDIANAPOLISIN4623901/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06592 6005 EAST WASHINGTON STREET
INDIANAPOLISIN4621901/01/2019 08/01/2020
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06594 8935 EAST 21ST STREET
INDIANAPOLISIN4621901/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06595 3808 EAST WASHINGTON ST
INDIANAPOLISIN4620101/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06637 200 S. HARRISON
SHELBYVILLEIN4617601/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06640 265 SO. SCATTERFIELD RD
ANDERSONIN4601201/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06651 2003 BROADWAY
ANDERSONIN4601201/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06661 263 W MORGAN ST.
KNIGHTSTOWNIN4614801/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06612 5110 E. 38TH ST.
INDIANAPOLISIN4621801/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06583 1715 MAIN STREET
BEECH GROVEIN4610707/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06616 425 E MEMORIAL DR
MUNCIEIN4730207/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06618 105 NORTH PARK AVE
ALEXANDRIAIN4600107/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06617 100 N ANDERSON ST.
ELWOODIN4603607/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 02311 2215 SOUTH SHELBY STREET
INDIANAPOLISIN4620307/01/2019  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 07052 2029 W WASHINGTON ST
INDIANAPOLISIN4622207/01/2019 10/31/2020
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 03297 4935 S. ARLINGTON
INDIANAPOLISIN4623704/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06549 1545 NORTH MERIDIAN ST.
INDIANAPOLISIN4620204/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06566 2550 CONNER ST.
NOBLESVILLEIN4606004/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06573 2330 EAST 46TH ST.
INDIANAPOLISIN4620504/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06585 5605 NORTH POST RD.
INDIANAPOLISIN4621604/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06599 715 E. BROADWAY
FORTVILLEIN4604004/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06600 1530 N. SHADELAND AVE.
INDIANAPOLISIN4621904/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06605 9550 ALLISONVILLE RD.
INDIANAPOLISIN4625004/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06608 5026 WEST US 52
NEW PALESTINEIN4616304/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06623 201 S. TILLOTSON AVENUE
MUNCIEIN4730404/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06638 2419 NICHOL AVE
ANDERSONIN4601604/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06645 101 WEST 1ST ST.
RUSHVILLEIN4617304/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06654 8970 S. MERIDIAN ST.
INDIANAPOLISIN4621704/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06656 3824 MAIN STREET
ANDERSONIN4601304/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06663 11 NORTH MORTON STREET
FRANKLININ4613104/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 07634 3805 N. GERMAN CHURCH RD.
INDIANAPOLISIN4623504/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.CVS PHARMACY # 16569 10202 E WASHINGTON ST
INDIANAPOLISIN4622904/01/2020  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06643 220 S. MEMORIAL DR.
NEW CASTLEIN4736201/01/2021  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06644 640 SOUTH STATE ROAD 135
GREENWOODIN4614201/01/2021  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06603 5005 EAST 56TH ST.
INDIANAPOLISIN4622604/01/2021  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06556 651 EAST MAIN STREET
DANVILLEIN4612210/01/2021  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06662 711 W. MILL ST.
MIDDLETOWNIN4735610/01/2021  
CHC26566-00HOOK-SUPERX, L.L.C.DBA CVS/PHARMACY # 3007 6010 SOUTH EMERSON AVENUE
INDIANAPOLISIN4623701/01/2023  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06597 10001 EAST WASHINGTON ST
INDIANAPOLISIN4622901/01/2023  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY #06622 1700 N. WALNUT ST
HARTFORD CITYIN4734801/01/2023  
CHC26566-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06658 620 E. STATE ST.
PENDLETONIN4606401/01/2023  
CHC26566-00HOOK-SUPERX, L.L.C.CVS/PHARMACY #11114 2800 ENTERPRISE ST STE 5
INDIANAPOLISIN46219-110601/01/2023  
CHC26566-16HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06637 200 S. HARRISON
SHELBYVILLEIN4617604/01/2024  
CHC26566-15HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06618 105 NORTH PARK AVE
ALEXANDRIAIN4600104/01/2024  
CHC26566-11HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 00045 6975 N. PENDLETON PIKE
INDIANAPOLISIN4622601/01/2025  
CHC26566-17HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 04633 1233 NORTH STATE ST.
GREENFIELDIN4614001/01/2025  
CHC26566-21HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06594 8935 EAST 21ST STREET
INDIANAPOLISIN4621901/01/2025  
CHC26566-22HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06613 4401 E. 10TH ST.
INDIANAPOLISIN4620101/01/2025  
CHC26566-25HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 08643 1030 N ARLINGTON AVE
INDIANAPOLISIN4621901/01/2025  
CHC26566-26HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06638 2419 NICHOL AVE
ANDERSONIN4601601/01/2025  
CHC26566-27HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06612 5110 E. 38TH ST.
INDIANAPOLISIN4621801/01/2025  
CHC26566-28HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06640 265 SO. SCATTERFIELD RD
ANDERSONIN4601201/01/2025  
CHC26566-29HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06585 5605 NORTH POST RD.
INDIANAPOLISIN4621601/01/2025  
CHC26566-30HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06656 3824 MAIN STREET
ANDERSONIN4601301/01/2025 07/01/2025
CHC26566-00JPCHC PHARMACY LLC5317 E 16TH ST
INDIANAPOLISIN4621801/01/2024  
CHC26566-00KROGER #J-8204445 EAST 10TH STREET
INDIANAPOLISIN4620104/01/2019  
CHC26566-00KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321701/01/2020  
CHC26566-00KROGER PHARMACY1571 N. STATE STREET
GREENFIELDIN4614004/01/2019  
CHC26566-00KROGER PHARMACY#116 680 TWIN AIRE DRIVE
INDIANAPOLISIN4620304/01/2019  
CHC26566-00KROGER PHARMACY #9955350 E. THOMPSON RD
INDIANAPOLISIN4623710/01/2019  
CHC26566-00KROGER PHARMACY CE 8948745 SOUTH EMERSON AVENUE
INDIANAPOLISIN4623710/01/2020 12/31/2023
CHC26566-00KROGER PHARMACY J-1007101 E. 10TH STREET
INDIANAPOLISIN4621904/01/2019  
CHC26566-00KROGER PHARMACY J-8045810 EAST 71ST STREET
INDIANAPOLISIN4622004/01/2019  
CHC26566-00KROGER PHARMACY J-86211101 PENDLETON PIKE
INDIANAPOLISIN4623604/01/2019  
CHC26566-00KROGER PHARMACY J-9741601 E MICHIGAN
SHELBYVILLEIN4617604/01/2019  
CHC26566-00MEDWORKS PHARMACYMEDWORKS INC 2123 INTELLIPLEX DR
SHELBYVILLEIN4617604/01/2025  
CHC26566-00MEIJER DISTRIBUTION INC #902721 WALKER AVE NW
GRAND RAPIDSMI4954407/01/2019 04/17/2020
CHC26566-00MEIJER PHARMACY #13111351 E. WASHINGTON ST
INDIANAPOLISIN4622907/01/2019 04/17/2020
CHC26566-00MEIJER PHARMACY #1366610 SCATTERFIELD RD
ANDERSONIN46013-960507/01/2019 04/17/2020
CHC26566-00MEIJER PHARMACY #46441255 COCA COLA DR.
BELLEVILLEMI48111-182707/01/2019 04/17/2020
CHC26566-00MEIJER STORES LIMITED PARTNERSHIPD/B/A MEIJER PHARMACY #463 1515 PROFIT DR.
FORT WAYNEIN4680807/01/2019 04/17/2020
CHC26566-00OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/01/2024  
CHC26566-00OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276504/01/2024  
CHC26566-00OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/01/2024  
CHC26566-00OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/01/2024  
CHC26566-00OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/01/2024  
CHC26566-00OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/01/2024  
CHC26566-00OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/01/2024  
CHC26566-00OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/01/2024  
CHC26566-00OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265504/01/2024  
CHC26566-00OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/01/2024  
CHC26566-00OPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970504/01/2024  
CHC26566-00OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/01/2024  
CHC26566-00OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/01/2024  
CHC26566-00OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/01/2024  
CHC26566-00OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/01/2024  
CHC26566-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2022  
CHC26566-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2022  
CHC26566-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2022  
CHC26566-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/01/2024  
CHC26566-00REM CORPORATIONDBA COMMUNITY MEDICAL CENTER PHARM 1311 N. ARLINGTON AVE.
SUITE 101 		INDIANAPOLISIN4621901/01/2019 11/30/2019
CHC26566-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CHC26566-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CHC26566-00THE KROGER CO#920 120 S MEMORIAL DR
NEW CASTLEIN4736204/01/2019 12/31/2023
CHC26566-00THE KROGER SAV-ON PHCY #94510450 E WASHINGTON ST
INDIANAPOLISIN4622904/01/2019  
CHC26566-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2018  
CHC26566-00WAL-MART PHARMACY #10-17282321 CHARLES STREET
ANDERSONIN4601307/01/2019  
CHC26566-00WAL-MART PHARMACY 10-08842500 PROGRESS PKWY
SHELBYVILLEIN4617601/01/2025  
CHC26566-30WAL-MART PHARMACY 10-08842500 PROGRESS PKWY
SHELBYVILLEIN4617601/01/2025 07/01/2025
CHC26566-00WAL-MART PHARMACY 10-11411965 NORTH STATE STREET
GREENFIELDIN4614004/01/2018  
CHC26566-00WAL-MART PHARMACY 10-15578300 E. 96TH ST
FISHERSIN4603707/01/2019  
CHC26566-00WAL-MART PHARMACY 10-158010617 E WASHINGTON
INDIANAPOLISIN4622901/01/2019  
CHC26566-00WAL-MART PHARMACY 10-17583167 S STATE RD #3
NEW CASTLEIN4736210/01/2024  
CHC26566-00WAL-MART PHARMACY 10-27877325 NO. KEYSTONE AVENUE
INDIANAPOLIS (N)IN4624010/01/2024  
CHC26566-00WAL-MART PHARMACY 10-34351133 NORTH EMERSON ROAD
GREENWOODIN4614310/01/2024  
CHC26566-00WAL-MART PHARMACY 10-352910735 PENDLETON PIKE
INDIANAPOLISIN4623607/01/2019  
CHC26566-00WAL-MART PHARMACY 10-54434650 SOUTH EMERSON AVE.
INDIANAPOLISIN4620307/01/2019  
CHC26566-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2018  
CHC26566-00WALGREEN CODBA: WALGREENS #10487 6745 E SOUTHPORT ROAD
INDIANAPOLISIN46237-972810/01/2018  
CHC26566-00WALGREEN CODBA: WALGREENS #10606 8945 MADISON AVENUE
INDIANAPOLISIN4622710/01/2018 01/05/2023
CHC26566-00WALGREEN CODBA: WALGREENS #10073 2400 W SYCAMORE STREET
KOKOMOIN4690107/01/2024  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 02800 8905 E 10TH ST
INDIANAPOLISIN4621904/01/2014  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 09278 11025 E WASHINGTON ST
INDIANAPOLISIN4622904/01/2014 03/01/2024
CHC26566-00WALGREEN CO.DBA: WALGREENS #13874 985 N. ARLINGTON AVE
INDIANAPOLISIN4621904/01/2014  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 03194 9050 E. 38TH STREET
INDIANAPOLISIN4623504/01/2014 08/01/2018
CHC26566-00WALGREEN CO.DBA: WALGREENS #21381 2920 E 38TH ST
INDIANAPOLISIN4621807/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 02798 3205 E WASHINGTON ST
INDIANAPOLISIN4620107/01/2017 11/04/2019
CHC26566-00WALGREEN CO.DBA: WALGREENS # 02956 1808 ALBANY ST
BEECH GROVEIN4610707/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 03065 4555 N SHADELAND AVE
INDIANAPOLISIN4622607/01/2017 11/09/2023
CHC26566-00WALGREEN CO.DBA: WALGREENS # 04592 700 US HIGHWAY 31 S
GREENWOODIN4614307/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 05393 20 S. MORTON ST.
FRANKLININ4613107/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 06761 3736 S SCATTERFIELD RD
ANDERSONIN4601307/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 07174 1195 N STATE STREET
GREENFIELDIN46140-120707/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 07788 320 S SCATTERFIELD RD
ANDERSONIN46012-360107/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 09489 1010 EAST STATE RD 44
SHELBYVILLEIN46176-177007/01/2017 11/16/2023
CHC26566-00WALGREEN CO.DBA: WALGREENS SPECIALTY PHARMACY #16317 335 MASSACHUSETTS AVENUE
INDIANAPOLISIN4620407/01/2017  
CHC26566-00WALGREEN CO.DBA: WALGREENS #21257 902 E HANNA AVE
INDIANAPOLISIN4622710/01/2018  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 03442 7506 N SHADELAND AVE
INDIANAPOLISIN4625010/01/2018  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 03609 5095 E. THOMPSON RD.
INDIANAPOLISIN4623710/01/2018 05/21/2025
CHC26566-00WALGREEN CO.DBA: WALGREENS # 05804 455 EAST EPLER AVE
INDIANAPOLISIN4622710/01/2018  
CHC26566-00WALGREEN CO.WALGREENS #10929 1650 EAST RAYMOND STREET
INDIANAPOLISIN46203-414310/01/2018 11/04/2019
CHC26566-00WALGREEN CO.DBA: WALGREENS #10973 1530 N MERIDIAN ST
INDIANAPOLISIN4620210/01/2018  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 15032 1290 N STATE RD 135
GREENWOODIN4614210/01/2018  
CHC26566-00WALGREEN CO.WALGREENS #16443 26 N. ARSENAL AVE.
INDIANAPOLISIN4620110/01/2018 02/18/2021
CHC26566-00WALGREEN CO.DBA WALGREENS #16558 1400 N RITTER AVE.
SUITE 140 		INDIANAPOLISIN4621910/01/2018  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 05853 720 S STATE RD 135
GREENWOODIN4614307/01/2019  
CHC26566-00WALGREEN CO.W002 DBA: WALGREENS #07690 100 N. MEMORIAL DR
NEW CASTLEIN4736207/01/2019  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 05978 11020 PENDLETON PIKE
INDIANAPOLISIN4623607/01/2019  
CHC26566-00WALGREEN CO.WALGREENS #16557 1550 E. COUNTY LINE ROAD
SUITE 150 		INDIANAPOLISIN4622705/04/2020  
CHC26566-00WALGREEN CO.DBA WALGREENS #16559 7120 CLEARVISTA DR.
SUITE 1900 		INDIANAPOLISIN4625601/01/2021  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 09129 2380 PLEASANT ST
NOBLESVILLEIN46060-362301/01/2022  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 02931 5199 N KEYSTONE
INDIANAPOLISIN4620501/01/2022  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 03142 3455 MANN ROAD
INDIANAPOLISIN4622104/01/2022  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 07031 9240 ROCKVILLE RD
INDIANAPOLISIN46234-255804/01/2022  
CHC26566-08WALGREEN CO.DBA: WALGREENS # 07788 320 S SCATTERFIELD RD
ANDERSONIN46012-360104/01/2024  
CHC26566-06WALGREEN CO.DBA: WALGREENS # 02800 8905 E 10TH ST
INDIANAPOLISIN4621904/01/2024  
CHC26566-13WALGREEN CO.DBA: WALGREENS # 06761 3736 S SCATTERFIELD RD
ANDERSONIN4601304/01/2024  
CHC26566-09WALGREEN CO.DBA: WALGREENS # 07174 1195 N STATE STREET
GREENFIELDIN46140-120704/01/2024  
CHC26566-23WALGREEN CO.DBA: WALGREENS # 03442 7506 N SHADELAND AVE
INDIANAPOLISIN4625004/01/2024  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 06944 3608 S LAFOUNTAIN STREET
KOKOMOIN46902-380907/01/2024  
CHC26566-00WALGREEN CO.DBA: WALGREENS # 10074 2345 E MARKLAND AVE
KOKOMOIN46901-624507/01/2024  
CHC26566-00Walgreens Central Fill #213994132Plainfield Rd
Ste 110 		IndianapolisIN46231-702104/01/2023  
CHC26566-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/01/2023  
CHC26566-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/01/2023  
CHC26566-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/01/2023  
CHC26566-00WALMART PHARMACY #10-57679354 AMBLESIDE DRIVE
FISHERSIN4603807/01/2019  
CHC26566-00WALMART PHARMACY #10-63905550 FALL CREEK PARKWAY N DRIVE
INDIANAPOLISIN4622607/01/2019  
CHC26566-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275610/01/2024  
CHC26566-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 7:53:22 AM2/10/2025 8:52:26 AM2/10/2025 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/21/2024 11:24 AM
Medicaid BillingMedicaid: NumberInsertChange Request 201026910K11/21/2024 11:24 AM
Medicaid BillingMedicaid: StateInsertChange Request IN11/21/2024 11:24 AM
Medicaid BillingNPI: NumberInsertChange Request 173048881811/21/2024 11:24 AM
Medicaid BillingNPI: StateInsertChange Request IN11/21/2024 11:24 AM
ContactsPrimary ContactUpdateChange RequestDale, Michael CFO Jane Pauley CHC 3179340751Marion, Dale 340B Program Manager Jane Pauley Community Health Center 31755206904/24/2024 10:13 AM
ContactsAuthorizing OfficialUpdateChange RequestMarion, Dale 340B Program Manager Jane Pauley Community Health Center 3175520690Knapp, Aaron Dir of Pharmacy Operations Jane Pauley Community Health Center 81263209174/24/2024 10:13 AM
DetailsLast Recertification DateUpdateRecertification1/30/2023 2:28:24 PM1/30/2024 7:53:22 AM1/30/2024 7:53 AM
DetailsLast Recertification DateUpdateRecertification2/1/2022 8:09:29 AM1/30/2023 2:28:24 PM1/30/2023 2:28 PM
DetailsLast Recertification DateUpdateRecertification2/4/2021 9:18:00 AM2/1/2022 8:09:29 AM2/1/2022 8:09 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestMarion, Dale Practice Manager Jane Pauley Community Health Center 3175520690Marion, Dale 340B Program Manager Jane Pauley Community Health Center 317552069010/6/2021 7:51 AM
DetailsLast Recertification DateUpdateRecertification1/27/2020 1:38:18 PM2/4/2021 9:18:00 AM2/4/2021 9:18 AM
ContactsPrimary ContactUpdateChange RequestBoyle, Amanda Executive Administrator Jane Pauley Community Health Center 3179340755Dale, Michael CFO Jane Pauley CHC 31793407516/8/2020 3:00 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 9:18:28 AM1/27/2020 1:38:18 PM1/27/2020 1:38 PM
DetailsLast Recertification DateUpdateRecertification2/13/2018 2:13:06 PM1/29/2019 9:18:28 AM1/29/2019 9:18 AM
ContactsAuthorizing OfficialUpdateAO Change RequestDale, Michael Finance Director Jane Pauley CHC 3173558704Marion, Dale Practice Manager Jane Pauley Community Health Center 31755206906/14/2018 4:10 PM
ContactsPrimary ContactUpdateRecertificationDale, Michael Finance Director Jane Pauley CHC 3173558704Boyle, Amanda Executive Administrator Jane Pauley Community Health Center 31793407552/13/2018 2:13 PM
DetailsLast Recertification DateUpdateRecertification2/15/2017 12:00:00 AM2/13/2018 2:13:06 PM2/13/2018 2:13 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/13/2018 2:13 PM
ContactsAuthorizing OfficialUpdate Dale, Michael Finance Director 3173558704Dale, Michael Finance Director Jane Pauley CHC 317355870410/16/2017 10:35 AM
ContactsPrimary ContactUpdate Dale, Michael Finance Director 3173558704Dale, Michael Finance Director Jane Pauley CHC 317355870410/16/2017 10:35 AM
ContactsAuthorizing OfficialInsert  Dale, Michael Finance Director 31735587044/17/2017 8:21 AM
ContactsPrimary ContactUpdate Jones, Mariya Property Manager 3173558214Dale, Michael Finance Director 31735587044/17/2017 8:21 AM
ContactsSigned ByInsert  Dale, Michael Finance Director 31735586962/15/2017 3:06 PM
AddressesMain AddressInsert   1107 N STATE ST GREENFIELD, IN 46140-12072/15/2017 3:06 PM
DetailsLast Recertification DateUpdate 3/3/2016 12:00:00 AM2/15/2017 12:00:00 AM2/15/2017 3:06 PM
ContactsPrimary ContactInsert  Jones, Mariya Property Manager 317355821412/19/2016 4:39 PM
AddressesBilling AddressInsert  Jane Pauley Community Health Center, Inc. 1503 N. Mitthoeffer Rd. Indianapolis, IN 462293/3/2016 8:07 AM
DetailsLast Recertification DateUpdate  3/3/2016 12:00:00 AM3/3/2016 8:07 AM
DatesParticipating Approval DateUpdate  1/22/2015 12:00:00 AM1/22/2015 6:20 PM
DetailsStateUpdate PendingActive1/22/2015 6:20 PM
DatesStart DateUpdate  4/1/2015 12:00:00 AM1/22/2015 6:20 PM
Details340B IDUpdate ONLINE_REG_48967CHC26566-091/20/2015 4:26 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_489671/13/2015 4:12 PM
DetailsLast Recertification DateInsert   1/13/2015 4:12 PM
DetailsGrant NumberInsert  H80CS265661/13/2015 4:12 PM
Details340B IDInsert  ONLINE_REG1/13/2015 4:12 PM
DetailsIs Authorizing Official EHB DataInsert  False1/13/2015 4:12 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/13/2015 4:12 PM
DetailsMedicare Provider NumberInsert   1/13/2015 4:12 PM
DetailsEntity NameInsert  JANE PAULEY COMMUNITY HEALTH CENTER, INC.1/13/2015 4:12 PM
DetailsProgram CodeInsert  CH1/13/2015 4:12 PM
DetailsEntity SubnameInsert  Jane Pauley Community Health Center at Greenfield1/13/2015 4:12 PM
DatesParticipating Approval DateInsert   1/13/2015 4:12 PM
DetailsStateInsert  Pending1/13/2015 4:12 PM
DatesRegistration DateInsert  1/13/2015 12:00:00 AM1/13/2015 4:12 PM
DatesSigned By DateInsert  1/13/2015 12:00:00 AM1/13/2015 4:12 PM
DatesStart DateInsert   1/13/2015 4:12 PM
TerminationsTermination CommentsInsert   1/13/2015 4:12 PM
TerminationsTermination DateInsert   1/13/2015 4:12 PM
TerminationsTermination Effective DateInsert   1/13/2015 4:12 PM
TerminationsTermination ReasonInsert   1/13/2015 4:12 PM