Covered Entity Details

DSH490052AY RIVERSIDE REGIONAL MEDICAL CENTER (Terminated) - information as of 5/19/2025 12:53:43 AM

Main Details

Name

RIVERSIDE REGIONAL MEDICAL CENTER

Subdivision Name

RVS PAIN MGMT & REHAB SPECIALISTS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH490052AY

Medicare Provider Number

490052

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/14/2015

Participating Start Date

10/1/2015

Participating Approval Date

8/12/2015

Last Recertification Date

9/2/2021

Termination Date
Termination Reason

10/1/2022
Site closure

Contacts

Authorizing Official

Riverside Healthcare Association Inc
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015

Primary Contact

Riverside Health System
Cynthia Williams, VP/Chief Pharmacy Officer
(757) 784-1569

Addresses

Street Address

850 Enterprise Parkway, Suite 2000
Hampton, VA 23666

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
VA	004900529	1366547747

Shipping Addresses

Same as Street Address

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
DSH490052A	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Gastroenterology Specialists	101 PHILLIP ROTH STREET	NEWPORT NEWS	VA	Active
DSH490052AA	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Peninsula Surgery Center	12000 Warwick Blvd	Newport News	VA	Active
DSH490052AB	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Vascular Specialists	500 J Clyde Morris Blvd	Newport News	VA	Active
DSH490052AC	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Thoracic and Cardiovascular Surgery	500 J Clyde Morris Blvd	Newport News	VA	Active
DSH490052AD	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Cardiology Specialists Newport News	500 J Clyde Morris Blvd	Newport News	VA	Active
DSH490052AE	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Cardiology Specialists Gloucester	7547 Medical Drive	Gloucester	VA	Terminated
DSH490052AF	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Vascular Specialists	120 Kings Way, Suite 2600	Williamsburg	VA	Terminated
DSH490052AG	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Cardiology Specialists Hampton	850 Enterprise Parkway, Suite 1300	Hampton	VA	Active
DSH490052AH	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Cardiology Specialists Williamsburg	117 Bulifants Boulevard	Williamsburg	VA	Active
DSH490052AJ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Cardiology Specialists Newport News	11803 Jefferson Avenue	Newport News	VA	Active
DSH490052AK	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Doctors Surgery Center	120 Kings Way	Williamsburg	VA	Active
DSH490052AL	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE PULMONARY AND SLEEP SPECI	12200 WARWICK BLVD 290	NEWPORT NEWS	VA	Terminated
DSH490052AM	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE RHEUMATOLOGY SPECIALISTS	850 Enterprise Parkway	Hampton	VA	Active
DSH490052AN	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS ENDOCRINOLOGY & DIABETES SPECIA	120 KINGS WAY	WILLIAMSBURG	VA	Terminated
DSH490052AP	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS PAIN MGMT AND REHAB SPECIALISTS	7570 MEDICAL DR	GLOUCESTER	VA	Terminated
DSH490052AQ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE RENAL SPECIALISTS	7552 HOSPITAL DR	GLOUCESTER	VA	Terminated
DSH490052AR	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE ORTHOPEDIC SPECIALISTS	120 KINGS WAY	WILLIAMSBURG	VA	Terminated
DSH490052AS	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE VASCULAR SPECIALISTS	7570 MEDICAL DR	GLOUCESTER	VA	Terminated
DSH490052AT	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE ORTHOPEDIC SPECIALISTS	850 ENTERPRISE PKWY 2000	HAMPTON	VA	Terminated
DSH490052AU	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE WEIGHT LOSS SPECIALISTS	850 ENTERPRISE PKWY	HAMPTON	VA	Terminated
DSH490052AV	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE RENAL SPECIALISTS	739 THIMBLE SHOALS BLVD	NEWPORT NEWS	VA	Active
DSH490052AW	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS ORTHO, SPORTS MED & PHYSIATRY	12200 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052AX	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS ENDOCRINOLOGY & DIABETES SPECIA	12200 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052AY	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS PAIN MGMT & REHAB SPECIALISTS	850 Enterprise Parkway, Suite 2000	Hampton	VA	Terminated
DSH490052AZ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE HPT RDS NEURO & SPINE SPE	12200 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052B	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE HAMPTON SURGERY CENTER	850 ENTERPRISE PARKWAY, SUITE 1000	HAMPTON	VA	Active
DSH490052BA	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE HPT RDS NEURO & SPINE SPE	120 KINGS WAY	WILLIAMSBURG	VA	Active
DSH490052BB	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE SURGICAL SPECIALISTS	109 PHILIP ROTH ST	NEWPORT NEWS	VA	Active
DSH490052BC	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE GASTROENTEROLOGY SPECIALI	120 Kings Way	WILLIAMSBURG	VA	Active
DSH490052BD	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS EAR, NOSE & THROAT PHYS & SURGE	120 KINGS WAY	WILLIAMSBURG	VA	Active
DSH490052BE	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS YORK RIVER ORTHO & SPORTS MED	7584 HOSPITAL DRIVE	GLOUCESTER	VA	Terminated
DSH490052BF	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE UROLOGY SPECIALISTS	7552 HOSPITAL DR	GLOUCESTER	VA	Terminated
DSH490052BG	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE ORTHOPEDIC SPECIALISTS	7544 HOSPITAL DR	GLOUCESTER	VA	Terminated
DSH490052BH	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE SURGICAL SPECIALISTS	7554 HOSPITAL DR	GLOUCESTER	VA	Terminated
DSH490052BJ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE GASTROENTEROLOGY SPECIALI	7547 MEDICAL DR	GLOUCESTER	VA	Active
DSH490052BK	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS EAR, NOSE & THROAT PHYS & SURGE	7570 HOSPITAL DRIVE	GLOUCESTER	VA	Terminated
DSH490052BL	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS EAR, NOSE & THROAT PHYS & SURGE	895 City Center Blvd	NEWPORT NEWS	VA	Active
DSH490052BM	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS PARTNERS IN WOMEN'S HEALT ONC	12100 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052BN	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE NEUROVASCULAR SPECIALISTS	12200 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052BP	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE SURGICAL SPECIALISTS	120 KINGS WAY	WILLIAMSBURG	VA	Terminated
DSH490052BQ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RVS Pain Mgmt Specs / Pain Management	120 Kings Way	Williamsburg	VA	Active
DSH490052BR	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Plastic and Reconstructive Surgery Specialists	109 Philip Roth Street	Newport News	VA	Active
DSH490052BS	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Surgery Spec Plastic Surgery and Reconstructive / Plastic Surgery	7554 Hospital Drive	Gloucester	VA	Terminated
DSH490052BT	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Urology Specialists - Urology	850 Enterprise Parkway	Hampton	VA	Active
DSH490052BU	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Rheumatology Specialist - Rheumatology	120 Kings Way	Williamsburg	VA	Active
DSH490052BV	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Gastroenterology Specialists - Gastroenterology	850 Enterprise Parkway	Hampton	VA	Active
DSH490052BW	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Gastroenterology Specialists - Gastroenterology	12200 Warwick Blvd	Newport News	VA	Terminated
DSH490052BX	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Williamsburg Infusion Center - Ambulatory Infusion	120 Kings Way	Williamsburg	VA	Active
DSH490052BY	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Infectious Disease Assoc - Infectious Disease	12420 Warwick Blvd	Newport News	VA	Active
DSH490052BZ	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	OrthoConnect - Orthopedics	12200 Warwick Blvd	Newport News	VA	Active
DSH490052C	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Orthopedic, Sports Medicine and Physiatry Specialists	12420 WARWICK BOULEVARD	NEWPORT NEWS	VA	Terminated
DSH490052CA	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE MENTAL HLTH AND REC CTR - Addiction Intensive Outpatient Program	2244 EXECUTIVE DR	HAMPTON	VA	Active
DSH490052CB	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE MENTAL HLTH AND REC CTR - Addiction Partial Hospitalization Program	2244 EXECUTIVE DR	HAMPTON	VA	Active
DSH490052CC	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RENAL SPECIALISTS WILLIAMSBURG - Renal	120 Kings Way	WILLIAMSBURG	VA	Active
DSH490052CD	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Mental Health Outpatient Services - Mental Health	2244 Executive Drive	HAMPTON	VA	Active
DSH490052CE	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Mental Health Intensive Outpatient Program - Mental Health	2244 Executive Drive	HAMPTON	VA	Active
DSH490052CF	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Mental Health Partial Hospitalization Program - Mental Health	2244 Executive Drive	Hampton	VA	Active
DSH490052CG	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	HAMPTON INFUSION CENTER - INFUSION	850 Enterprise Parkway	Hampton	VA	Active
DSH490052D	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - WILLIAMSBURG	120 KINGS WAY	WILLIAMSBURG	VA	Active
DSH490052E	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - NEWPORT NEWS	12100 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052F	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - GLOUCESTER	7544 MEDICAL DRIVE	GLOUCESTER	VA	Active
DSH490052G	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - CHESAPEAKE	110 WIMBLEDON SQUARE	CHESAPEAKE	VA	Active
DSH490052H	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - VIRGINIA BEACH	1200 First Colonial Road	Virginia Beach	VA	Active
DSH490052J	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Neurology Specialists	12200 WARWICK BLVD	NEWPORT NEWS	VA	Active
DSH490052K	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	RIVERSIDE CANCER INFUSION CENTER - SUFFOLK	5839 Harbour View Blvd	SUFFOLK	VA	Active
DSH490052L	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Hospital Inc dba Riverside Hospice	12420 Warwick Blvd	Newport News	VA	Terminated
DSH490052M	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Diagnostic and Breast Imaging Center	895 City Center Blvd	Newport News	VA	Active
DSH490052N	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Diagnostic Center Williamsburg	120 Kings Way	Williamsburg	VA	Active
DSH490052P	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Diagnostic Center Smithfield	202 Gumwood Drive	Smithfield	VA	Active
DSH490052Q	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Diagnostic Center Hampton	850 Enterprise Parkway	Hampton	VA	Active
DSH490052R	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Diabetes Center	12200 Warwick Blvd	Newport News	VA	Active
DSH490052S	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Pulmonary and Sleep Center	12200 Warwick Blvd	Newport News	VA	Active
DSH490052T	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Urology Specialists	120 Kings Way	Williamsburg	VA	Active
DSH490052U	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Urology Specialists	500 J Clyde Morris Blvd	Newport News	VA	Active
DSH490052V	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Pulmonary and Sleep Specialists	120 Kings Way	Williamsburg	VA	Active
DSH490052W	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Neurology and Sleep Specialists	12200 Warwick Blvd	Newport News	VA	Terminated
DSH490052X	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Neurology and Sleep Specialists	7547 Medical Drive	Gloucester	VA	Active
DSH490052Y	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Neurology and Sleep Specialists	120 Kings Way	Williamsburg	VA	Active
DSH490052Z	Child	DSH	RIVERSIDE REGIONAL MEDICAL CENTER	Riverside Neurology Specialists	850 Enterprise Parkway	Hampton	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Williams, Cynthia VP/Chief Pharmacy Officer Riverside Health System 7573165707	Williams, Cynthia VP/Chief Pharmacy Officer Riverside Health System 7577841569	7/12/2024 10:05 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/31/2021 12:00:00 AM	7/20/2022 7:33 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/20/2022 7:33 AM
Terminations	Termination Date	Update	Termination Request		10/1/2022 12:00:00 AM	7/20/2022 7:33 AM
Terminations	Termination Effective Date	Update	Termination Request		12/31/2021 12:00:00 AM	7/20/2022 7:33 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	7/20/2022 7:33 AM
Details	Last Recertification Date	Update	Recertification	8/31/2020 10:31:14 AM	9/2/2021 9:01:10 AM	9/2/2021 9:01 AM
Addresses	Main Address	Update	Recertification	245 CHESAPEAKE AVE NEWPORT NEWS, VA 23607-6038	850 Enterprise Parkway, Suite 2000 Hampton, VA 23666	8/31/2020 10:31 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1366547747	8/31/2020 10:31 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/31/2020 10:31 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1366547747 ( )		8/31/2020 10:31 AM
Details	Last Recertification Date	Update	Recertification	9/13/2019 2:18:39 PM	8/31/2020 10:31:14 AM	8/31/2020 10:31 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 8:14:31 AM	9/13/2019 2:18:39 PM	9/13/2019 2:18 PM
Details	Last Recertification Date	Update	Recertification	11/30/2017 8:57:45 AM	8/16/2018 8:14:31 AM	8/16/2018 8:14 AM
Medicaid Billing	NPI: Number	Update	Change Request	1093731549	1366547747	3/27/2018 11:55 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/30/2017 8:57:45 AM	11/30/2017 8:57 AM
Contacts	Primary Contact	Update		Williams, Cynthia VP/Chief Pharmacy Officer 7573165707	Williams, Cynthia VP/Chief Pharmacy Officer Riverside Health System 7573165707	10/13/2017 11:52 AM
Contacts	Authorizing Official	Update		AUSTIN JR., WILLIAM W. SENIOR VP & CFO 7575347015	AUSTIN JR., WILLIAM W. SENIOR VP & CFO Riverside Healthcare Association Inc 7575347015	10/11/2017 10:46 AM
Contacts	Signed By	Update		AUSTIN JR., WILLIAM W. SENIOR VP & CFO 7575347015	AUSTIN JR., WILLIAM W. SENIOR VP & CFO Riverside Healthcare Association Inc 7575347015	10/11/2017 10:46 AM
Contacts	Authorizing Official	Insert			AUSTIN JR., WILLIAM W. SENIOR VP & CFO 7575347015	7/13/2017 3:59 PM
Contacts	Signed By	Insert			AUSTIN JR., WILLIAM W. SENIOR VP & CFO 7575347015	7/13/2017 3:59 PM
Contacts	Primary Contact	Insert			Williams, Cynthia VP/Chief Pharmacy Officer 7573165707	6/26/2017 10:16 AM
Addresses	Main Address	Insert			245 CHESAPEAKE AVE NEWPORT NEWS, VA 23607-6038	8/19/2016 4:26 PM
Details	Last Recertification Date	Update			8/16/2016 12:00:00 AM	8/16/2016 11:29 AM
Dates	Participating Approval Date	Update			8/12/2015 12:00:00 AM	8/12/2015 4:16 PM
Details	State	Update		Pending	Active	8/12/2015 4:16 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	8/12/2015 4:16 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_53486	DSH490052AY	8/12/2015 2:52 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_53486	7/14/2015 9:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2015 9:15 AM
Medicaid Billing	Medicaid: Number	Insert			004900529	7/14/2015 9:15 AM
Medicaid Billing	Medicaid: State	Insert			VA	7/14/2015 9:15 AM
Medicaid Billing	NPI: Number	Insert			1093731549	7/14/2015 9:15 AM
Details	Last Recertification Date	Insert				7/14/2015 9:15 AM
Details	Grant Number	Insert				7/14/2015 9:15 AM
Details	340B ID	Insert				7/14/2015 9:15 AM
Details	Is Authorizing Official EHB Data	Insert				7/14/2015 9:15 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2015 9:15 AM
Details	Medicare Provider Number	Insert			490052	7/14/2015 9:15 AM
Details	Entity Name	Insert			RIVERSIDE REGIONAL MEDICAL CENTER	7/14/2015 9:15 AM
Details	Program Code	Insert			DSH	7/14/2015 9:15 AM
Details	Entity Subname	Insert			RVS PAIN MGMT & REHAB SPECIALISTS	7/14/2015 9:15 AM
Dates	Participating Approval Date	Insert				7/14/2015 9:15 AM
Details	State	Insert			Pending	7/14/2015 9:15 AM
Dates	Registration Date	Insert			7/14/2015 12:00:00 AM	7/14/2015 9:15 AM
Dates	Signed By Date	Insert			7/14/2015 12:00:00 AM	7/14/2015 9:15 AM
Dates	Start Date	Insert				7/14/2015 9:15 AM
Terminations	Termination Comments	Insert				7/14/2015 9:15 AM
Terminations	Termination Date	Insert				7/14/2015 9:15 AM
Terminations	Termination Effective Date	Insert				7/14/2015 9:15 AM
Terminations	Termination Reason	Insert				7/14/2015 9:15 AM