Covered Entity Details

DSH330214 NYU Langone Hospitals (Active) - information as of 4/23/2025 10:51:28 PM

Main Details

Name

NYU Langone Hospitals

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330214

Medicare Provider Number

330214

Additional Details

Current Program Status

Active

Registration Date

10/13/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/5/2015

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

NYU Langone Health
JOSEPH LHOTA, Chief Financial Officer
(646) 634-3670

Primary Contact

NYU Langone Health
Kristopher DaCosta, Director of 340B and Pharmacy Business & Analytics
(646) 754-9356

Addresses

Street Address

550 FIRST AVENUE
NEW YORK, NY 10016

Billing Address

NYU Langone Hospitals
PO Box 427
Elmsford, NY 10523

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
NY	03000066,03000048,02998552,02996078,02999026,02999071,00244211,02999062,03000057,03179260,04785324	1801992631,1821138959,1558809756,1730695263,1659470276,1437230034,1669578324,1619341716,1427616002,1114925567,1083612089,1831197797,1760480628

Shipping Addresses

Shipping Address 1

Safecor Health
317 New Boston Street
Suite 100
Woburn, MA 01801

Shipping Address 2

NYU Langone Hospitals, Perlmutter Cancer Center—Huntington - Infusion
789 Park Avenue
Huntington, NY 11743

Shipping Address 3

NYU Langone Hassenfeld and Fink Children's Center
ATTN Pharmacy Department
160 East 32nd Street
New York, NY 10016

Shipping Address 4

NYU Langone Rusk Ambulatory Care Center
ATTN Pharmacy Department
240 East 38th Street
New York, NY 10016

Shipping Address 5

NYU Langone Hospitals Tisch Hospital
ATTN Pharmacy Department
550 First Avenue Third Floor
New York, NY 10016

Shipping Address 6

NYU Langone Orthopedic Hospital
ATTN Pharmacy Department
301 East 17th Street
New York, NY 10003

Shipping Address 7

NYU Langone Perlmutter Cancer Center-Lake Success
ATTN Pharmacy Department
1st Floor, Suite 116, 1999 Marcus Avenue
New Hyde Park, NY 11042

Shipping Address 8

NYU Langone Perlmutter Cancer Center-34th Street
ATTN Pharmacy Department
160 East 34th Street
New York, NY 10016

Shipping Address 9

NYU Langone Hospital-Brooklyn
ATTN Pharmacy Department
150 55th Street
Brooklyn, NY 11220

Shipping Address 10

NYU Langone Orthopedic Center
ATTN Pharmacy Department
333 E 38th Street 4th Floor
New York, NY 10016

Shipping Address 11

NYU Langone Perlmutter Cancer Center-Midwood
ATTN Pharmacy Department
902 Quentin Road
Brooklyn, NY 11223

Shipping Address 12

NYU Langone Hospitals NYU Langone Perlmutter Cancer Center
120 Mineola Blvd Suite 600
Mineola, NY 11501

Shipping Address 13

NYU Langone Hospitals NYU Winthrop Hospital Ambulatory Surgery Cent Pharmacy Dept.
777 Zeckendorf Blvd
Garden City, NY 11530

Shipping Address 14

NYU Langone Hospitals Ambulatory Care Pharmacy
550 1st Ave
1st Floor
New York, NY 10016

Shipping Address 15

NYU Langone Hospital - Brooklyn Oncology & Infusion Center
ATTN Pharmacy Department
5718 Second Avenue
Brooklyn, NY 11220

Shipping Address 16

NYU Langone Hospital - Long Island
Pharmacy Dept.
259 First Street
Mineola, NY 11501

Shipping Address 17

NYU Langone Rusk Amb Care Center
Pharmacy Department
240 East 38th Street
Suite 2090
New York, NY 10016

Shipping Address 18

NYU Langone Hospitals
Steinberg Ambulatory Care Center
70 Atlantic Ave
4th Floor Pharmacy
Brooklyn, NY 11201

Shipping Address 19

NYU Langone Essex Crossing Ambulatory Surgery
171 Delancey Street
New York, NY 10002

Shipping Address 20

Inflammatory Bowel Disease Center
305 East 33rd Street
New York, NY 10016

Shipping Address 21

NYU Langone Hospitals
ATTN Pharmacy Department
882 3rd Ave, Floor 3
Industry City Building 10
Brooklyn, NY 11232

Shipping Address 22

Exel, Inc.
DHL Supply Chain (USA)
350 Salem Church Road
Mechanicsburg, PA 17050

Shipping Address 23

NYU Langone Hospitals
560 1st Ave
2nd Floor
New York, NY 10016

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	1875 LEXINGTON AVENUE CORP OF NEW YORK	D/B/A QUICK RX	1875 LEXINGTON AVENUE	NEW YORK	NY	10035-1003	01/17/2018	04/01/2018	08/14/2018	10/19/2022
Contract Detail	2355 2ND AVE NYS LLC	2355 2ND AVE		NEW YORK	NY	10035	10/14/2022	01/01/2023		01/01/2023
Contract Detail	ABC RX INC	DBA 1 STOP PHARMACY	1220 AVENUE P	BROOKLYN	NY	11229	04/23/2016	07/01/2016	08/17/2017	10/02/2017
Contract Detail	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	04/23/2016	07/01/2016	06/23/2018	06/23/2018
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/23/2016	07/01/2016		05/11/2017
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	04/23/2016	07/01/2016	06/22/2018	06/22/2018
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/23/2016	07/01/2016		05/11/2017
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/18/2022	04/01/2022		04/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/23/2016	07/01/2016		05/11/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/23/2016	07/01/2016	06/22/2018	06/22/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/23/2016	07/01/2016		05/11/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/19/2018	01/01/2019		01/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/18/2022	04/01/2022		04/01/2022
Contract Detail	AMERICARE PHARMACEUTICAL SERVICES INC	317 NASSAU BLVD	C/O PHARMACY	GARDEN CITY SOUTH	NY	11530	04/08/2022	07/01/2022	04/24/2023	04/24/2023
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	04/23/2016	07/01/2016	12/12/2019	01/10/2020
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	03/29/2017	04/01/2017	12/07/2020	12/11/2020
Contract Detail	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	04/23/2016	07/01/2016	12/12/2019	01/10/2020
Contract Detail	BIOLOGICS	BIOLOGICS BY MCKESSON	13000 WESTON PKWY, STE 105	CARY	NC	27513-2250	04/15/2019	07/01/2019		07/01/2019
Contract Detail	BIOLOGICS, INC.	BIOLOGICS BY MCKESSON	11800 WESTON PARKWAY	CARY	NC	27513	07/07/2020	07/07/2020	12/07/2020	12/11/2020
Contract Detail	BLONDELL RX CORP	D/B/A QUICK RX SPECIALTY PHARMACY	1642 EASTCHESTER ROAD	BRONX	NY	10461-2316	01/17/2018	04/01/2018		01/17/2018
Contract Detail	BRANAC INC	CONEY ISLAND PHARMACY	2720 MERMAID AVENUE	BROOKLYN	NY	11224-2006	01/17/2018	04/01/2018		01/17/2018
Contract Detail	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	01/18/2017	04/01/2017	12/12/2019	01/10/2020
Contract Detail	BRIOVARX OF MASSACHUSETTS, LLC	D/B/A BRIOVARX	BLDG 2 - UNIT A 145 BODWELL STREET	AVON	MA	02322	01/18/2017	04/01/2017	12/12/2019	01/10/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/18/2016	10/01/2016		05/11/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/08/2022	07/01/2022		07/01/2022
Contract Detail	CITY DRUGS NY CORP.	D/B/A CITY DRUGS	1551 YORK AVE	NEW YORK	NY	10028-6022	04/23/2016	07/01/2016	06/23/2018	06/23/2018
Contract Detail	CITY DRUGS NY CORP.	D/B/A CITY DRUGS	1551 YORK AVE	NEW YORK	NY	10028-6022	06/24/2018	07/01/2016	02/17/2023	02/28/2023
Contract Detail	CVS ALBANY, L.L.C	DBA: CVS/PHARMACY # 08968	222 EAST 34TH STREET	NEW YORK	NY	10016	04/23/2016	07/01/2016	10/31/2020	04/19/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07019	150 EAST 42ND ST.	NEW YORK	NY	10017	04/23/2016	07/01/2016	10/31/2020	04/19/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 08900	20 UNIVERSITY PLACE	NEW YORK	NY	10003	04/23/2016	07/01/2016	10/31/2020	04/19/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/14/2020	07/01/2020		07/01/2020
Contract Detail	DRUG MART SOLUTIONS LLC	D/B/A QUALITY RX	1611 UNIVERSITY AVENUE	BRONX	NY	10453	04/23/2016	07/01/2016	09/11/2020	12/11/2020
Contract Detail	DUANE READE	5008 5TH AVE		BROOKLYN	NY	11220	04/14/2020	07/01/2020		07/01/2020
Contract Detail	DUANE READE	155 EAST 34TH STREET		NEW YORK	NY	10016-4766	04/14/2020	07/01/2020		07/01/2020
Contract Detail	DUANE READE	380 AMSTERDAM AVENUE		NEW YORK	NY	10024-6208	04/14/2020	07/01/2020		07/01/2020
Contract Detail	ECHO DRUGS INC	260 BROADWAY		BROOKLYN	NY	11211-6229	04/23/2016	07/01/2016	02/18/2018	02/18/2018
Contract Detail	EQUAL CARE US	EQUAL CARE US INC	13342 39TH AVE UNIT 208	FLUSHING	NY	11354-4558	10/17/2016	01/01/2017		05/11/2017
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/15/2019	04/01/2019		04/01/2019
Contract Detail	KINGS PARK SLOPE INC	D/B/A KINGS SUPER PHARMACY	357 FLATBUSH AVE	BROOKLYN	NY	11238	04/23/2016	07/01/2016	06/23/2018	06/29/2018
Contract Detail	KINGS THIRD AVE PHARMACY	DBA: KINGS PHARMACY	1619 3RD AVE	NEW YORK	NY	10128-3459	04/23/2016	07/01/2016	06/23/2018	06/29/2018
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	04/23/2016	07/01/2016		05/11/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	OPTION CARE	870 N. ARLINGTON HEIGHTS RD SUITE 101	ITASCA	IL	60143	01/15/2019	04/01/2019		04/01/2019
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	01/15/2019	04/01/2019		04/01/2019
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/18/2017	04/01/2017	12/07/2020	12/11/2020
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	03/10/2021	03/10/2021		03/10/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/18/2017	04/01/2017		05/11/2017
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/18/2017	04/01/2017		05/11/2017
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	02/01/2017	04/01/2017		05/11/2017
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/07/2020	07/07/2020		07/22/2020
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/14/2020	07/01/2020	10/12/2022	10/14/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/18/2016	10/01/2016		05/11/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	04/15/2019	07/01/2019	10/31/2020	04/19/2023
Contract Detail	QUICKRX LTC PHARMA INC.	1646 EASTCHESTER ROAD		BRONX	NY	10461	01/17/2018	04/01/2018	08/21/2018	10/19/2022
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/23/2016	07/01/2016		05/11/2017
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/23/2016	07/01/2016		05/11/2017
Contract Detail	TOTAL CARE RX, INC.	WORLD'S FAIR PHARMACY	22310 UNION TPKE	OAKLAND GARDENS	NY	11364-3645	04/17/2018	07/01/2018		04/17/2018
Contract Detail	TRINITY HOMECARE, L.L.C.	OPTION CARE	4805 METROPOLITAN AVE STE 3-02	RIDGEWOOD	NY	11385	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16078	205 8TH AVENUE	NEW YORK	NY	10011	04/14/2020	07/01/2020		07/01/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10135	298 FIRST AVE	NEW YORK	NY	10009-1850	04/14/2020	07/01/2020		07/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/14/2020	07/01/2020		07/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/14/2020	07/01/2020		07/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/14/2020	07/01/2020	10/01/2021	10/20/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/14/2020	07/01/2020		07/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330214A	Child	DSH	NYU Langone Hospitals	NYU Langone Levit Medical- Ambulatory Care	1220 Avenue P	Brooklyn	NY	Active
DSH330214AA	Child	DSH	NYU Langone Hospitals	NYU Langone Ambulatory Care—23rd Street	324 East 23rd Street	New York	NY	Active
DSH330214AB	Child	DSH	NYU Langone Hospitals	NYU Langone Outpatient Surgery Center	339 East 38th Street	New York	NY	Active
DSH330214AC	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-EMG	333 East 38th Street	New York	NY	Active
DSH330214AD	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-Pain Management	333 East 38th Street	New York	NY	Terminated
DSH330214AE	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-PT, OT, Physiatry	333 East 38th Street	New York	NY	Terminated
DSH330214AF	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center- Radiology	333 East 38th Street	New York	NY	Active
DSH330214AG	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-Spine	333 East 38th Street	New York	NY	Terminated
DSH330214AH	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-Sports Medicine	333 East 38th Street	New York	NY	Terminated
DSH330214AJ	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-Infusion	333 East 38th Street	New York	NY	Active
DSH330214AK	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Center-Rheumatology	333 East 38th Street	New York	NY	Active
DSH330214AL	Child	DSH	NYU Langone Hospitals	Initiative for Women with Disabilities	318 East 23rd Street	New York	NY	Active
DSH330214AM	Child	DSH	NYU Langone Hospitals	Cardiac Catheterization Laboratory	550 First Avenue	New York	NY	Terminated
DSH330214AN	Child	DSH	NYU Langone Hospitals	Day Surgery Center	550 First Avenue	New York	NY	Terminated
DSH330214AP	Child	DSH	NYU Langone Hospitals	Preston Robert Tisch Center for Men’s Health	555 Madison Avenue	New York	NY	Active
DSH330214AQ	Child	DSH	NYU Langone Hospitals	Observation	570 First Avenue	New York	NY	Terminated
DSH330214AR	Child	DSH	NYU Langone Hospitals	Ronald O. Perelman Center for Emergency Services	570 First Avenue	New York	NY	Terminated
DSH330214AS	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital - Ambulatory Center	240 East 18th Street, Suite 21	New York	NY	Terminated
DSH330214AT	Child	DSH	NYU Langone Hospitals	NYU Langone Occupational & Industrial Orthopedic Center	63 Downing Street	New York	NY	Terminated
DSH330214AU	Child	DSH	NYU Langone Hospitals	Radiology - Joseph S. & Diane H. Steinberg Ambulatory Care Center	70 Atlantic Ave	Brooklyn	NY	Active
DSH330214AV	Child	DSH	NYU Langone Hospitals	Cobble Hill Emergency Department at the Joseph S. & Diane H. Steinberg Ambulatory Care Center	70 Atlantic Ave	Brooklyn	NY	Active
DSH330214AW	Child	DSH	NYU Langone Hospitals	NYU Langone Levit Medical—Canarsie	9708 Seaview Avenue	Brooklyn	NY	Terminated
DSH330214AX	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center—Rego Park- Imaging	97-77 Queens Boulevard	Rego Park	NY	Active
DSH330214AY	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center—Rego Park-Infusion Center	97-77 Queens Boulevard	Rego Park	NY	Active
DSH330214AZ	Child	DSH	NYU Langone Hospitals	Ambulatory Care Rego Park	97-85 Queens Blvd.	Rego Park	NY	Active
DSH330214B	Child	DSH	NYU Langone Hospitals	Rusk Rehabilitation at Levit Medical—Avenue P	1300 Avenue P	Brooklyn	NY	Terminated
DSH330214BA	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Ambulance Services	150 55th St	Brooklyn	NY	Active
DSH330214BB	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Anesthesiology	150 55th St	Brooklyn	NY	Terminated
DSH330214BC	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Cardiac Catheterization Lab	150 55th St	Brooklyn	NY	Active
DSH330214BD	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Cat Scan	150 55th St	Brooklyn	NY	Active
DSH330214BE	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Brooklyn-Delivery Room & Labor Room	150 55th St	Brooklyn	NY	Active
DSH330214BF	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Electrocardiology	150 55th St	Brooklyn	NY	Active
DSH330214BG	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Electroencephalography	150 55th St	Brooklyn	NY	Active
DSH330214BH	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Brooklyn-Emergency (Non-Distinct Observation)	150 55th St	Brooklyn	NY	Active
DSH330214BJ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Emergency Room	150 55th St	Brooklyn	NY	Active
DSH330214BK	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Endoscopy	150 55th St	Brooklyn	NY	Active
DSH330214BL	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-ER Trauma Center	150 55th St	Brooklyn	NY	Terminated
DSH330214BM	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Magnetic Resonance Imaging	150 55th St	Brooklyn	NY	Active
DSH330214BN	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Minor Procedure Room	150 55th St	Brooklyn	NY	Terminated
DSH330214BP	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - Sunset Park	5718 Second Avenue	Brooklyn	NY	Active
DSH330214BQ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Operating Room	150 55th St	Brooklyn	NY	Active
DSH330214BR	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Physical Therapy	150 55th St	Brooklyn	NY	Terminated
DSH330214BS	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Radioisotope	150 55th St	Brooklyn	NY	Active
DSH330214BT	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Radiology-Diagnostic	150 55th St	Brooklyn	NY	Active
DSH330214BU	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Radiology-Special Procedures	150 55th St	Brooklyn	NY	Terminated
DSH330214BV	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Radiology-Therapeutic(Radiation Oncology)	5718 Second Ave	Brooklyn	NY	Active
DSH330214BW	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Recovery Room	150 55th St	Brooklyn	NY	Terminated
DSH330214BX	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Renal Dialysis	150 55th St	Brooklyn	NY	Terminated
DSH330214BY	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Respiratory Therapy	150 55th St	Brooklyn	NY	Terminated
DSH330214BZ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Ultrasound Diagnostic	150 55th St	Brooklyn	NY	Terminated
DSH330214C	Child	DSH	NYU Langone Hospitals	Stephen D. Hassenfeld Children’s Center for Cancer & Blood Disorders	160 East 32nd Street	New York	NY	Active
DSH330214CA	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital-Brooklyn-Vascular Lab	150 55th St	Brooklyn	NY	Active
DSH330214CB	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital-Immediate Care	301 E 17th Street	New York	NY	Active
DSH330214CC	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital-Neuro Rehab	301 E 17th Street	New York	NY	Active
DSH330214CD	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital-Center for Children	301 E 17th Street	New York	NY	Active
DSH330214CE	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital - Peri-Op	301 E 17th Street	New York	NY	Active
DSH330214CF	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital-Radiology	301 E 17th Street	New York	NY	Active
DSH330214CG	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Speech & Swallow	160 East 34th Street	New York	NY	Terminated
DSH330214CH	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Integrated Medicine	160 East 34th Street	New York	NY	Active
DSH330214CJ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- ENT	160 East 34th Street	New York	NY	Active
DSH330214CK	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Pulmonology	160 East 34th Street	New York	NY	Active
DSH330214CL	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Psych	160 East 34th Street	New York	NY	Terminated
DSH330214CM	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Ortho	160 East 34th Street	New York	NY	Active
DSH330214CN	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-38th Street- Gastroenterology	240 East 38th Street, New York, NY 10016	New York	NY	Active
DSH330214CP	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island LVAD Transplant	222 Station Plaza	Mineola	NY	Active
DSH330214CQ	Child	DSH	NYU Langone Hospitals	NYU Langone Orthopedic Hospital Primary Care Center	318 East 23rd Street	New York	NY	Active
DSH330214CR	Child	DSH	NYU Langone Hospitals	Tisch Peri-Op	550 1st Avenue	New York	NY	Terminated
DSH330214CS	Child	DSH	NYU Langone Hospitals	Fink Children’s Ambulatory Care Center	160 East 32nd St	New York	NY	Active
DSH330214CT	Child	DSH	NYU Langone Hospitals	Diabetic Foot & Ankle Center	318 East 23rd Street	New York	NY	Active
DSH330214CU	Child	DSH	NYU Langone Hospitals	HCC Electroconvulsive Therapy	550 1st Avenue	New York	NY	Terminated
DSH330214CV	Child	DSH	NYU Langone Hospitals	Tisch Cardiovascular Services	550 First Avenue	New York	NY	Terminated
DSH330214CW	Child	DSH	NYU Langone Hospitals	HCC Cardiovascular Services	550 1st Avenue	New York	NY	Terminated
DSH330214CX	Child	DSH	NYU Langone Hospitals	Tisch Radiology	550 1st Avenue	New York	NY	Terminated
DSH330214CY	Child	DSH	NYU Langone Hospitals	Tisch Radiation Oncology	550 1st Avenue	New York	NY	Terminated
DSH330214CZ	Child	DSH	NYU Langone Hospitals	Tisch Acute Care	550 1st Avenue	New York	NY	Terminated
DSH330214D	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center-34th Street- Breast Imaging	160 East 34th Street	New York	NY	Terminated
DSH330214DA	Child	DSH	NYU Langone Hospitals	HCC Peri-Op	550 1st Avenue	New York	NY	Terminated
DSH330214DB	Child	DSH	NYU Langone Hospitals	HCC Acute Care	550 1st Avenue	New York	NY	Terminated
DSH330214DC	Child	DSH	NYU Langone Hospitals	Tisch Opthamology	550 1st Avenue	New York	NY	Terminated
DSH330214DD	Child	DSH	NYU Langone Hospitals	NYU Langone Transplant Institute	317 East 34th Street	New York	NY	Active
DSH330214DE	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center—Midwood	902 Quentin Road	Brooklyn	NY	Active
DSH330214DF	Child	DSH	NYU Langone Hospitals	NYU Langone Hospitals, Perlmutter Cancer Center—Huntington	789 Park Avenue	Huntington	NY	Active
DSH330214DG	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Endocrine - Endocrine	150 East 32nd Street	New York	NY	Active
DSH330214DH	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Cardiology - Cardiology	150 East 32nd Street	New York	NY	Active
DSH330214DJ	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Pediatrics - Pediatrics	150 East 32nd Street	New York	NY	Active
DSH330214DK	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Nephrology - Nephrology	150 East 32nd Street	New York	NY	Active
DSH330214DL	Child	DSH	NYU Langone Hospitals	NYU Langone Ambulatory Pharmacy Services	550 First Avenue	New York	NY	Terminated
DSH330214DM	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Behavioral Health	135 East 31st Street	New York	NY	Active
DSH330214DN	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Electrophysiology Lab	259 First Street	Mineola	NY	Active
DSH330214DP	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Mineola Dialysis	200 Old Country Road	Mineola	NY	Active
DSH330214DQ	Child	DSH	NYU Langone Hospitals	Wound Healing and Hyperbaric Medicine at NYU Langone Hospital - Long Island	211 Station Road	Mineola	NY	Active
DSH330214DR	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Operating Room	259 First Street	Mineola	NY	Active
DSH330214DS	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Nuclear Medicine	259 First Street	Mineola	NY	Active
DSH330214DT	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island MRI	120 Mineola Blvd	Mineola	NY	Terminated
DSH330214DU	Child	DSH	NYU Langone Hospitals	NYU Langone Essex Crossing Ambulatory Surgery	171 Delancey Street	New York	NY	Active
DSH330214DV	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Diabetes Education Center	173 Mineola Blvd	Mineola	NY	Terminated
DSH330214DW	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Labor and Delivery	259 First Street	Mineola	NY	Active
DSH330214DX	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Breast Imaging Center	120 Mineola Blvd	Mineola	NY	Active
DSH330214DY	Child	DSH	NYU Langone Hospitals	NYCyberKnife at Perlmutter Cancer Center - Manhattan	150 Amsterdam Avenue	New York	NY	Active
DSH330214DZ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Cardiac Cath Lab	259 First Street	Mineola	NY	Active
DSH330214E	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 34th Street - Diagnostic Imaging	160 East 34th Street	New York	NY	Active
DSH330214EA	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Endoscopy	259 First Street	Mineola	NY	Active
DSH330214EB	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island MRI	259 First Street	Mineola	NY	Active
DSH330214EC	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Women's Wellness OB GYN	1 Fulton Avenue	Hempstead	NY	Active
DSH330214ED	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island PET Scan	259 First Street	Mineola	NY	Terminated
DSH330214EE	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Radiation Oncology	259 First Street	Mineola	NY	Active
DSH330214EF	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Radiology PET/CT Scan	259 First Street	Mineola	NY	Active
DSH330214EG	Child	DSH	NYU Langone Hospitals	NYU Winthrop Hospital Acute Dialysis - NYU Winthrop Hospital Acute Dialysis	259 First Street	Mineola	NY	Terminated
DSH330214EH	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center at NYU Langone Hospital - Long Island Radiation Oncology	264 Old Country Road	Mineola	NY	Active
DSH330214EJ	Child	DSH	NYU Langone Hospitals	NYU Langone Fink Diabetes	135 East 31st Street	New York	NY	Active
DSH330214EK	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Radiology Diagnostic	259 First Street	Mineola	NY	Active
DSH330214EL	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Non-Invasive Cardiology	259 First Street	Mineola	NY	Active
DSH330214EM	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Pediatric Center	175 Fulton Avenue	Hempstead	NY	Active
DSH330214EN	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island ASU	259 First Street	Mineola	NY	Active
DSH330214EP	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Infusion Center	200 Old Country Road	Mineola	NY	Terminated
DSH330214EQ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Hempstead High School Based Clinic	201 President Street	Hempstead	NY	Active
DSH330214ER	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Radiology Special Procedures	259 First Street	Mineola	NY	Active
DSH330214ES	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center Infusion Center at NYU Langone - 120 Mineola Boulevard	120 Mineola Blvd	Mineola	NY	Active
DSH330214ET	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Bethpage Dialysis	530 Hicksville Road	Bethpage	NY	Active
DSH330214EU	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Sun Harbor Dialysis	255 Warner Avenue	Roslyn Heights	NY	Terminated
DSH330214EV	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Hyperbaric	259 First Street	Mineola	NY	Active
DSH330214EW	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Special Procedures	222 Station Plaza	Mineola	NY	Active
DSH330214EX	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Ambulatory Surgery Center - Garden City	777 Zeckendorf Blvd	Garden City	NY	Active
DSH330214EY	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Blood Draw Station	222 Station Plaza	Mineola	NY	Terminated
DSH330214EZ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Primary Care Clinic - Mineola	222 Station Plaza	Mineola	NY	Active
DSH330214F	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 34th Street - Hematology/Oncology	160 East 34th Street	New York	NY	Active
DSH330214FA	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Sleep Disorder Center	1300 Franklin Avenue	Garden City	NY	Active
DSH330214FB	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Cancer Center For Kids	120 Mineola Blvd	Mineola	NY	Active
DSH330214FC	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Emergency Department	259 First Street	Mineola	NY	Active
DSH330214FD	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Radiology	120 Mineola Blvd	Mineola	NY	Active
DSH330214FE	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Recovery Room	259 First Street	Mineola	NY	Terminated
DSH330214FF	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Sonography	259 First Street	Mineola	NY	Terminated
DSH330214FG	Child	DSH	NYU Langone Hospitals	NYU Langone Health - Transplant Rivergate	403 East 34th Street	New York	NY	Active
DSH330214FH	Child	DSH	NYU Langone Hospitals	Inflammatory Bowel Disease Center	305 E. 33rd Street	New York	NY	Active
DSH330214FJ	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - Hematology/Oncology Clinic - Blood & Marrow Transplant	610 Second Avenue	New York	NY	Active
DSH330214FK	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center at Joseph S. and Diane H. Steinberg Ambulatory Care Center at NYU Langone - Oncology	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FL	Child	DSH	NYU Langone Hospitals	Joseph S. and Diane H. Steinberg Same Day Surgery - Same Day Surgery	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FM	Child	DSH	NYU Langone Hospitals	Joseph S. and Diane H. Steinberg Ambulatory Care Center - Cardiology - Cardiology	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FN	Child	DSH	NYU Langone Hospitals	Joseph S. and Diane H. Steinberg Ambulatory Care Center - Nuclear Medicine - Nuclear Medicine	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FP	Child	DSH	NYU Langone Hospitals	Joseph S. and Diane H. Steinberg Ambulatory Care Center - CT Scan - CT Scan	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FQ	Child	DSH	NYU Langone Hospitals	Joseph S. and Diane H. Steinberg Ambulatory Care Center - MRI - MRI	70 Atlantic Avenue	Brooklyn	NY	Active
DSH330214FR	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Pulmonary Rehab - Pulmonary Rehab	100 Hospital Road	Patchogue	NY	Approved
DSH330214FS	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Cardiac Rehab - Cardiac Rehab	100 Hospital Road	Patchogue	NY	Approved
DSH330214FT	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Perioperative Services - Perioperative Services	101 Hospital RD	Patchogue	NY	Approved
DSH330214FU	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Recovery Services - Recovery Services	101 Hospital RD	Patchogue	NY	Approved
DSH330214FV	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Radiology-Diagnostic - Radiology-Diagnostic	101 Hospital Road	Patchogue	NY	Approved
DSH330214FW	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Emergency Medicine - Emergency Medicine	101 Hospital Road	Patchogue	NY	Approved
DSH330214FX	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Radiology-Special Procedures - Radiology-Special Procedures	101 Hospital Road	Patchogue	NY	Approved
DSH330214FY	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - EKG - EKG	101 Hospital Road	Patchogue	NY	Approved
DSH330214FZ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Radiology-Ultrasound - Radiology-Ultrasound	101 Hospital Road	Patchogue	NY	Approved
DSH330214G	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 34th Street - Infusion Center	160 East 34th Street	New York	NY	Active
DSH330214GA	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Non-Invasive Cardiology - Non-Invasive Cardiology	101 Hospital Road	Patchogue	NY	Approved
DSH330214GB	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Anesthesiology - Anesthesiology	101 Hospital Road	Patchogue	NY	Approved
DSH330214GC	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Radiology-Cat Scan - Radiology-Cat Scan	101 Hospital Road	Patchogue	NY	Approved
DSH330214GD	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Radiology-MRI - Radiology-MRI	101 Hospital Road	Patchogue	NY	Approved
DSH330214GE	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Cardiac and Vascular Services - Cardiac and Vascular Services	101 Hospital Road	Patchogue	NY	Approved
DSH330214GF	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Infusion Services - Infusion Services	101 Hospital Road	Patchogue	NY	Approved
DSH330214GG	Child	DSH	NYU Langone Hospitals	Suffolk Dialysis Center - Dialysis	109 West Main St	Shirley	NY	Approved
DSH330214GH	Child	DSH	NYU Langone Hospitals	Outpatient Chemical Dependency Center - Chemical Dependency Center	550 Montauk Highway	Shirley	NY	Approved
DSH330214GJ	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Suffolk - Wound Care & Hyperbaric Medicine - Wound Care & Hyperbaric Medicine	33 Medford Avenue	Patchogue	NY	Approved
DSH330214GK	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center Radiation Oncology at NYU Langone - Mineola - Radiation Oncology	200 Old Country Road	Mineola	NY	Approved
DSH330214GL	Child	DSH	NYU Langone Hospitals	NYU Langone Hospital - Long Island Endoscopy Center, Mineola - Endoscopy	211 Station Road	Mineola	NY	Approved
DSH330214GM	Child	DSH	NYU Langone Hospitals	NYU Langone Cardiac Rehabilitation—Mineola - Cardiac Rehabilitation	212 Jericho Turnpike	Mineola	NY	Approved
DSH330214H	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 34th Street - Radiation Oncology	160 East 34th Street	New York	NY	Active
DSH330214J	Child	DSH	NYU HOSPITALS CENTER	NYU Langone Levit Medical Arts Pavilion - Ambulatory Care	1616 East 13th Street	Brooklyn	NY	Terminated
DSH330214K	Child	DSH	NYU Langone Hospitals	NYU Langone Brooklyn Endoscopy & Ambulatory Surgery Center	1630 East 14th Street	Brooklyn	NY	Active
DSH330214L	Child	DSH	NYU Langone Hospitals	NYU Langone Rehabilitation at Levit Medical—Bensonhurst	1902 86th Street	Brooklyn	NY	Terminated
DSH330214M	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - Lake Success	1999 Marcus Avenue	Lake Success	NY	Active
DSH330214N	Child	DSH	NYU Langone Hospitals	NYU Langone Endoscopy Center - Upper East Side	207 E. 84th Street	New York	NY	Active
DSH330214P	Child	DSH	NYU Langone Hospitals	Laura Perlmutter Center for Women's Imaging	221 Lexington Ave.	New York	NY	Active
DSH330214Q	Child	DSH	NYU Langone Hospitals	NYU Langone Ambulatory Care Center East 38th Street	240 East 38th Street, Floors 12, 13, 15, 16, 17, Ground and Mezzanine	New York	NY	Active
DSH330214R	Child	DSH	NYU Langone Hospitals	Helen L. & Martin S. Kimmel Hyperbaric & Advanced Wound Healing Center	240 East 38th Street, 13th Floor	New York	NY	Active
DSH330214S	Child	DSH	NYU Langone Hospitals	Center for the Study & Treatment of Pain	240 East 38th Street, 14th Floor	New York	NY	Active
DSH330214T	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 38th Street	240 East 38th Street, 18th Floor	New York	NY	Active
DSH330214U	Child	DSH	NYU Langone Hospitals	NYU Langone Gastroenterology Associates	240 East 38th Street, 23rd Floor	New York	NY	Terminated
DSH330214V	Child	DSH	NYU Langone Hospitals	Ambulatory Care Center - Outpatient Surgery	240 East 38th Street, Floors 3, 20, and 21	New York	NY	Active
DSH330214W	Child	DSH	NYU Langone Hospitals	Skin & Cancer Unit	240 East 38th Street, 11th and 12th Floor	New York	NY	Active
DSH330214X	Child	DSH	NYU Langone Hospitals	Multiple Sclerosis Comprehensive Care Center	240 East 38th Street, Floors 12, 13, and 18	New York	NY	Active
DSH330214Y	Child	DSH	NYU Langone Hospitals	Perlmutter Cancer Center - 38th Street - Hematology/Oncology	240 East 38th Street, Floors 19, 20	New York	NY	Active
DSH330214Z	Child	DSH	NYU Langone Hospitals	Harkness Center for Dance Injuries	318 East 23rd Street	New York	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 7:12:45 PM	8/14/2024 3:30:42 PM	8/14/2024 3:30 PM
Addresses	Shipping Address	Update	Change Request	NYU Langone Hospitals ATTN Pharmacy Department 70 Atlantic Ave 4th Floor Pharmacy Brooklyn, NY 11201	NYU Langone Hospitals Steinberg Ambulatory Care Center 70 Atlantic Ave 4th Floor Pharmacy Brooklyn, NY 11201	7/25/2024 7:48 AM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals 560 1st Ave 2nd Floor New York, NY 10016	4/22/2024 7:38 AM
Contacts	Authorizing Official	Update	Change Request	Widawsky, Daniel J Chief Financial Officer NYU Langone Health 2122633092	LHOTA, JOSEPH Chief Financial Officer NYU Langone Health 6466343670	2/7/2024 8:21 AM
Addresses	Shipping Address	Delete	Recertification	NYU Langone Health-Cobble Hill ATTN Pharmacy Department 83 Amity Street Brooklyn, NY 11201		9/6/2023 7:12 PM
Addresses	Shipping Address	Insert	Recertification		Exel, Inc. DHL Supply Chain (USA) 350 Salem Church Road Mechanicsburg, PA 17050	9/6/2023 7:12 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 11:18:40 AM	9/6/2023 7:12:45 PM	9/6/2023 7:12 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals ATTN Pharmacy Department 882 3rd Ave, Floor 3 Industry City Building 10 Brooklyn, NY 11232	6/1/2023 7:45 AM
Addresses	Billing Address	Insert	Group Change Request		NYU Langone Hospitals PO Box 427 Elmsford, NY 10523	5/16/2023 3:41 PM
Addresses	Shipping Address	Update	Change Request	NYU Langone Hospitals ATTN Pharmacy Department 70 Atlantic Ave Room 485 Brooklyn, NY 11201	NYU Langone Hospitals ATTN Pharmacy Department 70 Atlantic Ave 4th Floor Pharmacy Brooklyn, NY 11201	5/15/2023 8:09 AM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Essex Crossing Ambulatory Surgery 171 Delancey Street New York, NY 10002	5/15/2023 8:09 AM
Addresses	Shipping Address	Insert	Change Request		Inflammatory Bowel Disease Center 305 East 33rd Street New York, NY 10016	5/15/2023 8:09 AM
Addresses	Shipping Address	Insert	Group Change Request		NYU Langone Hospitals ATTN Pharmacy Department 70 Atlantic Ave Room 485 Brooklyn, NY 11201	2/13/2023 1:32 PM
Addresses	Shipping Address	Insert	Group Change Request		NYU Langone Rusk Amb Care Center Pharmacy Department 240 East 38th Street Suite 2090 New York, NY 10016	10/17/2022 8:03 AM
Addresses	Shipping Address	Delete	Recertification	NYU Langone Hospitals Ambulatory Care Pharmac 550 1st Ave 1st Floor New York, NY 10016		9/12/2022 11:18 AM
Addresses	Shipping Address	Delete	Recertification	NYU Langone Hospitals Perlmutter Cancer Center- Sunset Park ATTN Pharmacy Department 5718 Second Avenue Brooklyn, NY 11220		9/12/2022 11:18 AM
Addresses	Shipping Address	Delete	Recertification	NYU Langone Hospitals NYU Winthrop Hospital Pharmacy Dept. 259 First Street Mineola, NY 11501		9/12/2022 11:18 AM
Addresses	Shipping Address	Insert	Recertification		NYU Langone Hospitals Ambulatory Care Pharmacy 550 1st Ave 1st Floor New York, NY 10016	9/12/2022 11:18 AM
Addresses	Shipping Address	Insert	Recertification		NYU Langone Hospital - Brooklyn Oncology & Infusion Center ATTN Pharmacy Department 5718 Second Avenue Brooklyn, NY 11220	9/12/2022 11:18 AM
Addresses	Shipping Address	Insert	Recertification		NYU Langone Hospital - Long Island Pharmacy Dept. 259 First Street Mineola, NY 11501	9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (AL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (AK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (AZ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (AR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (CA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (CO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (CT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (DC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (FL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (GA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (HI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (ID)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (IL)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (IN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (IA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (KS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (KY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (LA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (ME)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MD)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MS)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MO)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (MT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (NE)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (NV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (NJ)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (NM)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (NC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (ND)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (OH)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (OK)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (OR)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (PA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (RI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (SC)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (TN)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (TX)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (UT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (VT)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (VA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (WA)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (WV)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (WI)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1083612089 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114925567 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427616002 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1437230034 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558809756 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1619341716 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659470276 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669578324 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730695263 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1760480628 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801992631 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1821138959 (WY)		9/12/2022 11:18 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831197797 (WY)		9/12/2022 11:18 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 4:42:24 PM	9/12/2022 11:18:40 AM	9/12/2022 11:18 AM
Contacts	Primary Contact	Update	Group Change Request	Yu, Kenny Senior Director of Pharmacy Services NYU Langone Health 2122635051	DaCosta, Kristopher Director of 340B and Pharmacy Business & Analytics NYU Langone Health 6467549356	7/21/2022 7:00 AM
Addresses	Shipping Address	Update	Change Request	NYU Langone Hospitals Ambulatory Care Pharmac 550 1st Ave New York, NY 10016	NYU Langone Hospitals Ambulatory Care Pharmac 550 1st Ave 1st Floor New York, NY 10016	5/11/2022 12:55 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 3:27:39 PM	9/10/2021 4:42:24 PM	9/10/2021 4:42 PM
Contacts	Primary Contact	Update	Profile Change Request	Yu, Kenny Director of Pharmacy, 340B Program and Pharmacy Business & Analytics NYU Langone Health 6467549356	Yu, Kenny Senior Director of Pharmacy Services NYU Langone Health 2122635051	9/2/2021 11:29 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (AS)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (FM)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (GU)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (MH)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (MP)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (PW)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (PR)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083612089 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114925567 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427616002 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437230034 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558809756 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619341716 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659470276 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1669578324 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730695263 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760480628 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801992631 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821138959 (VI)		4/12/2021 3:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831197797 (VI)		4/12/2021 3:30 PM
Addresses	Shipping Address	Delete	Change Request	NYU Winthrop Hospital 259 First Street, ATTN Pharmacy Dept Mineola, NY 11501		10/28/2020 2:54 PM
Addresses	Shipping Address	Delete	Change Request	NYU Winthrop Hospital DBA NYU Winthrop Institutes for Care Infusion Center Pharmacy Dept Suite 600 120 Mineola Blvd Mineola, NY 11501		10/28/2020 2:54 PM
Addresses	Shipping Address	Delete	Change Request	NYU Winthrop Hospital Ambulatory Surgery Center Pharmacy Department 777 Zeckendorf Blvd Garden City, NY 11530		10/28/2020 2:54 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals NYU Winthrop Hospital Pharmacy Dept. 259 First Street Mineola, NY 11501	10/28/2020 2:54 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals NYU Langone Perlmutter Cancer Center 120 Mineola Blvd Suite 600 Mineola, NY 11501	10/28/2020 2:54 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals NYU Winthrop Hospital Ambulatory Surgery Cent Pharmacy Dept. 777 Zeckendorf Blvd Garden City, NY 11530	10/28/2020 2:54 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083612089	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114925567	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427616002	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437230034	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558809756	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619341716	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1659470276	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669578324	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760480628	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801992631	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821138959	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831197797	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/1/2020 3:27 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 1:06:08 PM	9/1/2020 3:27:39 PM	9/1/2020 3:27 PM
Contacts	Primary Contact	Update	Profile Change Request	Yu, Kenny Director of Pharmacy, 340B Program NYU Langone Health 6467549356	Yu, Kenny Director of Pharmacy, 340B Program and Pharmacy Business & Analytics NYU Langone Health 6467549356	8/17/2020 5:37 PM
Addresses	Shipping Address	Insert	Change Request		NYU Winthrop Hospital 259 First Street, ATTN Pharmacy Dept Mineola, NY 11501	10/24/2019 7:26 AM
Addresses	Shipping Address	Insert	Change Request		NYU Winthrop Hospital DBA NYU Winthrop Institutes for Care Infusion Center Pharmacy Dept Suite 600 120 Mineola Blvd Mineola, NY 11501	10/24/2019 7:26 AM
Addresses	Shipping Address	Insert	Change Request		NYU Winthrop Hospital Ambulatory Surgery Center Pharmacy Department 777 Zeckendorf Blvd Garden City, NY 11530	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02999026	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02999071	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00244211	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02999062	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	10/24/2019 7:26 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1427616002	10/24/2019 7:26 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1114925567	10/24/2019 7:26 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1083612089	10/24/2019 7:26 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1831197797	10/24/2019 7:26 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1760480628	10/24/2019 7:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		03000066	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		03000048	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02998552	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02996078	9/4/2019 12:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	9/4/2019 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1659470276	9/4/2019 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437230034	9/4/2019 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1669578324	9/4/2019 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1619341716	9/4/2019 12:02 PM
Details	Last Recertification Date	Update	Recertification	9/3/2018 9:17:04 AM	8/20/2019 1:06:08 PM	8/20/2019 1:06 PM
Addresses	Shipping Address	Delete	Change Request	NYU Langone Perlmutter Cancer Center-Bay Ridge ATTN Pharmacy Department 8721 5th Avenue Brooklyn, NY 11209		6/25/2019 3:27 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals Perlmutter Cancer Center- Sunset Park ATTN Pharmacy Department 5718 Second Avenue Brooklyn, NY 11220	6/25/2019 3:27 PM
Addresses	Shipping Address	Delete	Change Request	NYU Langone Hospitals, Perlmutter Cancer Center – Midwood c/o Pharmacy 902 Quentin Road, First Floor Brooklyn, NY 11223		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Lutheran Medical Center Infusion Site 8721 5th Avenue 3rd Floor Brooklyn, NY 11209		12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Health-Cobble Hill ATTN Pharmacy Department 83 Amity Street Brooklyn, NY 11201	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals Tisch Hospital ATTN Pharmacy Department 550 First Avenue Third Floor New York, NY 10016	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Orthopedic Hospital ATTN Pharmacy Department 301 East 17th Street New York, NY 10003	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Perlmutter Cancer Center-Lake Success ATTN Pharmacy Department 1st Floor, Suite 116, 1999 Marcus Avenue New Hyde Park, NY 11042	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Perlmutter Cancer Center-34th Street ATTN Pharmacy Department 160 East 34th Street New York, NY 10016	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospital-Brooklyn ATTN Pharmacy Department 150 55th Street Brooklyn, NY 11220	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Orthopedic Center ATTN Pharmacy Department 333 E 38th Street 4th Floor New York, NY 10016	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals Ambulatory Care Pharmac 550 1st Ave New York, NY 10016	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Perlmutter Cancer Center-Midwood ATTN Pharmacy Department 902 Quentin Road Brooklyn, NY 11223	12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Perlmutter Cancer Center-Bay Ridge ATTN Pharmacy Department 8721 5th Avenue Brooklyn, NY 11209	12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hospital Center 550 First Ave ATTN Hospital Pharmacy New York, NY 10016		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hospitals Center - Center for Musculoskeletal Care 333 East 38th Street Pharmacy Department New York, NY 10016		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hospitals Center - NYU Hospital for Joint Diseases 301 East 17th Street C/O Pharmacy Dept New York, NY 10003		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hospitals Center - Cancer Institute Clinical Center 160 E 34th Street, 7th Floor C/O Pharmacy New York, NY 10016		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hosptials Center - NYU Langone Arena Oncology Center Pharmacy 1999 Marcus Avenue, Suite 116 Suite 116 Lake Success, NY 10042		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hospitals Center - NYU Cobble Hill 83 Amity Street Brooklyn, NY 11201		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU - Lutheran Medical Center 150 55th St Attention: Pharmacy Brooklyn, NY 11220		12/21/2018 2:49 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hosptials Center - Faculty Practice Offices Pharmacy 530 First Avenue New York, NY 10016		12/21/2018 2:49 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Rusk Ambulatory Care Center ATTN Pharmacy Department 240 East 38th Street New York, NY 10016	12/17/2018 1:33 PM
Addresses	Shipping Address	Delete	Change Request	NYU Hosptials Center - Ambulatory Care Center 240 East 38th Street, 18th Floor Pharmacy Department New York, NY 10016		12/17/2018 1:33 PM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hassenfeld and Fink Children's Center ATTN Pharmacy Department 160 East 32nd Street New York, NY 10016	12/6/2018 8:43 AM
Addresses	Shipping Address	Delete	Change Request	NYU Hospitals Center - Hassenfeld Childrens Cancer Center - PHA 160 East 32nd Street New York, NY 10016		12/6/2018 8:43 AM
Addresses	Shipping Address	Insert	Recertification		NYU Lutheran Medical Center Infusion Site 8721 5th Avenue 3rd Floor Brooklyn, NY 11209	9/3/2018 9:17 AM
Addresses	Shipping Address	Insert	Recertification		NYU Langone Hospitals, Perlmutter Cancer Center—Huntington - Infusion 789 Park Avenue Huntington, NY 11743	9/3/2018 9:17 AM
Addresses	Shipping Address	Delete	Recertification	NYU Lutheran Medical Center Infusion Site 8721 5th Avenue Brooklyn, NY 11209		9/3/2018 9:17 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1730695263	9/3/2018 9:17 AM
Details	Last Recertification Date	Update	Recertification	11/3/2017 10:26:15 AM	9/3/2018 9:17:04 AM	9/3/2018 9:17 AM
Contacts	Authorizing Official	Update	AO Change Request	Grossman, Robert I Dean and CEO NYU Langone Health 2122563269	Widawsky, Daniel J Chief Financial Officer NYU Langone Health 2122633092	8/20/2018 9:35 AM
Contacts	Authorizing Official	Update	AO Change Request	Burke, Michael Corporate Chief Financial Officer NYU Langone Health 2122633092	Grossman, Robert I Dean and CEO NYU Langone Health 2122563269	7/12/2018 7:13 AM
Contacts	Primary Contact	Update	Profile Change Request	Yu, Kenny Director of Pharmacy, 340B Program NYU Langone Hopsitals 6467549356	Yu, Kenny Director of Pharmacy, 340B Program NYU Langone Health 6467549356	4/9/2018 4:21 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/3/2017 10:26:15 AM	11/3/2017 10:26 AM
Addresses	Shipping Address	Insert	Change Request		NYU Langone Hospitals, Perlmutter Cancer Center – Midwood c/o Pharmacy 902 Quentin Road, First Floor Brooklyn, NY 11223	10/20/2017 8:04 AM
Details	Entity Name	Update	Change Request	NYU HOSPITALS CENTER	NYU Langone Hospitals	10/20/2017 8:04 AM
Contacts	Authorizing Official	Update		Burke, Michael Corporate Chief Financial Officer 2122633092	Burke, Michael Corporate Chief Financial Officer NYU Langone Health 2122633092	10/2/2017 11:26 AM
Contacts	Primary Contact	Update		Yu, Kenny Director of Pharmacy, 340B Program 6467549356	Yu, Kenny Director of Pharmacy, 340B Program NYU Langone Hopsitals 6467549356	9/19/2017 7:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	OPA Edit		False	9/19/2017 7:23 AM
Medicaid Billing	Medicaid: Number	Insert	OPA Edit		04785324	9/19/2017 7:23 AM
Medicaid Billing	Medicaid: State	Insert	OPA Edit		NY	9/19/2017 7:23 AM
Medicaid Billing	NPI: Number	Insert	OPA Edit		1558809756	9/19/2017 7:23 AM
Contacts	Primary Contact	Insert			Yu, Kenny Director of Pharmacy, 340B Program 6467549356	7/17/2017 5:31 PM
Contacts	Signed By	Insert			Burke, Michael Corporate Chief Financial Officer 2122633092	7/17/2017 5:31 PM
Contacts	Authorizing Official	Insert			Burke, Michael Corporate Chief Financial Officer 2122633092	7/17/2017 5:31 PM
Addresses	Shipping Address	Delete		NYU Langone Pharmacy, Cobble Hill 83 Amity Street Brooklyn, NY 11201		6/14/2017 11:50 AM
Addresses	Main Address	Insert			550 FIRST AVENUE NEW YORK, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospital Center 550 First Ave ATTN Hospital Pharmacy New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospitals Center - Hassenfeld Childrens Cancer Center - PHA 160 East 32nd Street New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospitals Center - Center for Musculoskeletal Care 333 East 38th Street Pharmacy Department New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospitals Center - NYU Hospital for Joint Diseases 301 East 17th Street C/O Pharmacy Dept New York, NY 10003	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hosptials Center - Ambulatory Care Center 240 East 38th Street, 18th Floor Pharmacy Department New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospitals Center - Cancer Institute Clinical Center 160 E 34th Street, 7th Floor C/O Pharmacy New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hosptials Center - NYU Langone Arena Oncology Center Pharmacy 1999 Marcus Avenue, Suite 116 Suite 116 Lake Success, NY 10042	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hospitals Center - NYU Cobble Hill 83 Amity Street Brooklyn, NY 11201	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU - Lutheran Medical Center 150 55th St Attention: Pharmacy Brooklyn, NY 11220	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Hosptials Center - Faculty Practice Offices Pharmacy 530 First Avenue New York, NY 10016	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Lutheran Medical Center Infusion Site 8721 5th Avenue Brooklyn, NY 11209	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			Safecor Health 317 New Boston Street Suite 100 Woburn, MA 01801	6/14/2017 11:50 AM
Addresses	Shipping Address	Insert			NYU Langone Pharmacy, Cobble Hill 83 Amity Street Brooklyn, NY 11201	6/14/2017 11:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/14/2017 11:49 AM
Medicaid Billing	Medicaid: Number	Insert			03179260	6/14/2017 11:49 AM
Medicaid Billing	Medicaid: State	Insert			NY	6/14/2017 11:49 AM
Medicaid Billing	NPI: Number	Insert			1821138959	6/14/2017 11:49 AM
Details	Last Recertification Date	Update			8/10/2016 12:00:00 AM	8/10/2016 12:43 PM
Dates	Participating Approval Date	Update			11/5/2015 12:00:00 AM	11/5/2015 11:03 AM
Details	State	Update		Pending	Active	11/5/2015 11:03 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/5/2015 11:03 AM
Details	340B ID	Update		ONLINE_REG_55179	DSH330214	11/4/2015 9:18 AM
Details	340B ID	Update			ONLINE_REG_55179	10/13/2015 10:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/13/2015 10:26 AM
Medicaid Billing	Medicaid: Number	Insert			03000057	10/13/2015 10:26 AM
Medicaid Billing	Medicaid: State	Insert			NY	10/13/2015 10:26 AM
Medicaid Billing	NPI: Number	Insert			1801992631	10/13/2015 10:26 AM
Details	Last Recertification Date	Insert				10/13/2015 10:26 AM
Details	Grant Number	Insert				10/13/2015 10:26 AM
Details	340B ID	Insert				10/13/2015 10:26 AM
Details	Is Authorizing Official EHB Data	Insert				10/13/2015 10:26 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2015 10:26 AM
Details	Medicare Provider Number	Insert			330214	10/13/2015 10:26 AM
Details	Entity Name	Insert			NYU HOSPITALS CENTER	10/13/2015 10:26 AM
Details	Program Code	Insert			DSH	10/13/2015 10:26 AM
Details	Entity Subname	Insert				10/13/2015 10:26 AM
Dates	Participating Approval Date	Insert				10/13/2015 10:26 AM
Details	State	Insert			Pending	10/13/2015 10:26 AM
Dates	Registration Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 10:26 AM
Dates	Signed By Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 10:26 AM
Dates	Start Date	Insert				10/13/2015 10:26 AM
Terminations	Termination Comments	Insert				10/13/2015 10:26 AM
Terminations	Termination Date	Insert				10/13/2015 10:26 AM
Terminations	Termination Effective Date	Insert				10/13/2015 10:26 AM
Terminations	Termination Reason	Insert				10/13/2015 10:26 AM