Covered Entity Details

DSH170122Y Ascension Via Christi Hospitals Wichita, Inc (Active) - information as of 5/13/2025 1:37:32 AM

Main Details

Name

Ascension Via Christi Hospitals Wichita, Inc

Subdivision Name

VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH170122Y

Medicare Provider Number

170122

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/15/2016

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Ascension Via Christi
Todd Schroeder, VP Pharmacy
(316) 268-5580

Primary Contact

Ascension Via Christi Hospitals Wichita, Inc.
Sarah E Dodson, 340B Program Director
(316) 202-8759

Addresses

Street Address

1121 S CLIFTON AVE
WICHITA, KS 67218-2912

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

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

State	Medicaid Number	NPI Number
KS	30003933260051	1154314789,1871589333

Shipping Addresses

Shipping Address 1

Via Christi Hospital
Pharmacy Department
929 N. St. Francis
Wichita, KS 67214

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH170122A	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC ACU	3600 East Harry	Wichita	KS	Active
DSH170122AA	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Specialty Clinic Psych	1515 South Clifton Ave	WICHITA	KS	Terminated
DSH170122AB	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	Wound Care	848 N. St. Francis	Wichita	KS	Active
DSH170122AC	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	Transitional Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AD	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Pediatric Surgery Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AE	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Surgery Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AF	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Asthma Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AG	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Specialty Clinic Sports	707 N EMPORIA	WICHITA	KS	Active
DSH170122AH	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Pediatric Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AJ	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Ortho Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AK	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Osteopathic Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AL	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Muscular Dystrophy Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AM	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Cystic Fibrosis Clinic	707 N EMPORIA	WICHITA	KS	Active
DSH170122AN	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	Saint Francis / Ambulatory Infusion Center	929 N. St. Francis	Wichita	KS	Active
DSH170122AP	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA INC - BHS Partial Day Hospital	1515 S CLIFTON AVE	WICHITA	KS	Active
DSH170122AQ	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA INC - BHS Adolescent Partial Day	1515 S CLIFTON AVE	WICHITA	KS	Active
DSH170122AR	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ST JOSEPH CAMPUS - Medical 5E VCH SJ	3600 E HARRY ST	WICHITA	KS	Active
DSH170122AS	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	Special Procedures - Wound Care (Burn Clinic)	848 N. St. Francis	Wichita	KS	Active
DSH170122AT	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA INC - Radiation Oncology	817 N EMPORIA ST	WICHITA	KS	Active
DSH170122AU	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ST JOSEPH CAMPUS - Psychiatric Nursing Unit	3600 E HARRY ST	WICHITA	KS	Active
DSH170122AV	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ST JOSEPH CAMPUS - Cardiology Unit, Outpatient Observation Beds	3600 E HARRY ST	WICHITA	KS	Active
DSH170122AW	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ST JOSEPH CAMPUS - Adult Psychiatry ICU, Outpatient Observation Beds	3600 E HARRY ST	WICHITA	KS	Active
DSH170122AX	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ST JOSEPH CAMPUS - LDRP, Outpatient Observation Beds	3600 E HARRY ST	WICHITA	KS	Active
DSH170122AY	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	Ascension Via Christi Hospitals Wichita, Inc. - Community Cares	707 N EMPORIA	WICHITA	KS	Active
DSH170122AZ	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	31625 Emergency Department 025 - Emergency	1323 N A ST	WELLINGTON	KS	Active
DSH170122B	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC AIC	3600 East Harry	Wichita	KS	Terminated
DSH170122BA	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	18357 Infusion Services COVID19 001 - Intravenous Therapy	848 N. St. Francis	Wichita	KS	Active
DSH170122BB	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA CHRISTI HOSPITALS INC - Pharmacotherapy Clinic	707 N EMPORIA ST	WICHITA	KS	Active
DSH170122BC	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA HOSP WICHI INC - Endocrinologist	1515 S CLIFTON AVE STE 205	WICHITA	KS	Active
DSH170122BD	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA HOSP WICHI INC - Rheumatology	1515 S CLIFTON AVE STE 205	WICHITA	KS	Active
DSH170122BE	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA HOSP WICHI INC - Stroke Clinic	707 N EMPORIA ST	WICHITA	KS	Active
DSH170122BF	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA CHRISTI HOSPITAL WICHITA, INC. - INFUSION CENTER CLIFTON	1515 S CLIFTON	WICHITA	KS	Active
DSH170122BG	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	ASCENSION VIA HOSP WICHI INC - Cardiology	818 N EMPORIA ST	WICHITA	KS	Approved
DSH170122C	Child	DSH	Via Christi Hospitals Wichita, Inc	SJC Anesthesia	3600 East Harry	Wichita	KS	Terminated
DSH170122D	Child	DSH	Via Christi Hospitals Wichita, Inc	SJC CHF Clinic	3600 East Harry	Wichita	KS	Terminated
DSH170122E	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC CT Scan	3600 East Harry	Wichita	KS	Active
DSH170122F	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Diag Radiology	3600 East Harry	Wichita	KS	Active
DSH170122G	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Dialysis-	3600 East Harry	Wichita	KS	Active
DSH170122H	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC EchoCardiology	3600 East Harry	Wichita	KS	Active
DSH170122J	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC ED Services	3600 East Harry	Wichita	KS	Active
DSH170122K	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC MRI	3600 East Harry	Wichita	KS	Active
DSH170122L	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Neurodiagnostics	3600 East Harry	Wichita	KS	Active
DSH170122M	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Nuclear Card	3600 East Harry	Wichita	KS	Terminated
DSH170122N	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Nuclear Med	3600 East Harry	Wichita	KS	Active
DSH170122P	Child	DSH	Via Christi Hospitals Wichita, Inc	SJC Post Operative	3600 East Harry	Wichita	KS	Terminated
DSH170122Q	Child	DSH	Via Christi Hospitals Wichita, Inc	SJC Rad Therapy	3600 East Harry	Wichita	KS	Terminated
DSH170122R	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Forensic Nursing Services	3600 East Harry	Wichita	KS	Active
DSH170122T	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Special Proc	3600 East Harry	Wichita	KS	Active
DSH170122U	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Surgery/OR	3600 East Harry	Wichita	KS	Active
DSH170122V	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	SJC Ultrasound	3600 East Harry	Wichita	KS	Active
DSH170122W	Child	DSH	Via Christi Hospitals Wichita, Inc	SJC Vascular Lab	3600 East Harry	Wichita	KS	Terminated
DSH170122X	Child	DSH	VIA CHRISTI HOSPITAL WICHITA	VIA CHRISTI HOSPITALS WICHITA INC / VC CHF Clinic	848 N ST FRANCIS STE 1900	WICHITA	KS	Terminated
DSH170122Y	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic	1121 S CLIFTON AVE	WICHITA	KS	Active
DSH170122Z	Child	DSH	Ascension Via Christi Hospitals Wichita, Inc	VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic	707 N EMPORIA	WICHITA	KS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 12:41:37 PM	8/15/2024 2:28:17 PM	8/15/2024 2:28 PM
Contacts	Primary Contact	Update	Profile Change Request	Dodson, Sarah E 340B Program Director Ascension Via Christi Hospitals Wichita, Inc. 6202357965	Dodson, Sarah E 340B Program Director Ascension Via Christi Hospitals Wichita, Inc. 3162028759	8/13/2024 1:16 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100695200A (OK)		3/4/2024 1:00 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100695200I (OK)		3/4/2024 1:00 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1154314789 (OK)		3/4/2024 1:00 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1871589333 (OK)		3/4/2024 1:00 PM
Contacts	Authorizing Official	Update	AO Change Request	Antonios, Samer CCO Ascension.org 3162685865	Schroeder, Todd VP Pharmacy Ascension Via Christi 3162685580	1/12/2024 1:54 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:52:18 AM	8/28/2023 12:41:37 PM	8/28/2023 12:41 PM
Contacts	Authorizing Official	Update	AO Change Request	Garrelts, Jim C Vice President, Pharmacy Via Christi Hospitals Wichita, Inc 3162685580	Antonios, Samer CCO Ascension.org 3162685865	8/10/2023 5:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/31/2022 11:20 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30003933260051	10/31/2022 11:20 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	10/31/2022 11:20 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100080640B (KS)		10/31/2022 11:20 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100080640D (KS)		10/31/2022 11:20 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1700129699 (KS)		10/31/2022 11:20 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1700129699 (OK)		10/31/2022 11:20 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1174132161 (KS)		10/31/2022 11:20 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1174132161 (OK)		10/31/2022 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 3:15:26 PM	8/31/2022 11:52:18 AM	8/31/2022 11:52 AM
Details	Last Recertification Date	Update	Recertification	8/27/2020 9:03:13 AM	8/30/2021 3:15:26 PM	8/30/2021 3:15 PM
Medicaid Billing	Medicaid: Number	Update		100080640D	100080640D	12/10/2020 4:18 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1174132161	9/8/2020 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	9/8/2020 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1174132161	9/8/2020 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		OK	9/8/2020 10:23 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1700129699 ( )		8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154314789	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700129699	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871589333	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154314789	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700129699	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871589333	8/27/2020 9:03 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1154314789 ( )		8/27/2020 9:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1871589333 ( )		8/27/2020 9:03 AM
Details	Last Recertification Date	Update	Recertification	9/3/2019 11:51:38 AM	8/27/2020 9:03:13 AM	8/27/2020 9:03 AM
Contacts	Primary Contact	Update	Profile Change Request	Dodson, Sarah E 340B Program Coordinator Ascension Via Christi Hospitals Wichita, Inc. 6202357965	Dodson, Sarah E 340B Program Director Ascension Via Christi Hospitals Wichita, Inc. 6202357965	7/24/2020 12:41 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 3:41:54 PM	9/3/2019 11:51:38 AM	9/3/2019 11:51 AM
Contacts	Primary Contact	Update	Profile Change Request	Dodson, Sarah E 340B Program Coordinator Via Christi Hospitals Wichita, Inc. 6202357965	Dodson, Sarah E 340B Program Coordinator Ascension Via Christi Hospitals Wichita, Inc. 6202357965	3/12/2019 9:51 AM
Details	Entity Name	Update	Change Request	Via Christi Hospitals Wichita, Inc	Ascension Via Christi Hospitals Wichita, Inc	3/7/2019 11:25 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700129699	3/5/2019 8:58 AM
Contacts	Primary Contact	Update	Change Request	Garrelts, Jim Senior Director of Pharmacy Via Christi Hospitals Wichita, Inc. 3162685580	Dodson, Sarah E 340B Program Coordinator Via Christi Hospitals Wichita, Inc. 6202357965	11/21/2018 12:16 PM
Contacts	Authorizing Official	Update	Change Request	Labarca, Laurie Administrator - Hospital Operations Via Christi Hospitals Wichita, Inc. 3162685161	Garrelts, Jim C Vice President, Pharmacy Via Christi Hospitals Wichita, Inc 3162685580	11/11/2018 7:57 AM
Details	Last Recertification Date	Update	Recertification	11/3/2017 9:04:35 AM	8/28/2018 3:41:54 PM	8/28/2018 3:41 PM
Details	Entity Name	Update	Recertification	VIA CHRISTI HOSPITAL WICHITA	Via Christi Hospitals Wichita, Inc	11/3/2017 12:00 PM
Details	Last Recertification Date	Update	Recertification		11/3/2017 9:04:35 AM	11/3/2017 9:04 AM
Contacts	Primary Contact	Update	Recertification	Garrelts, Jim Senior Director of Pharmacy 3162685580	Garrelts, Jim Senior Director of Pharmacy Via Christi Hospitals Wichita, Inc. 3162685580	11/3/2017 9:00 AM
Contacts	Authorizing Official	Update		Labarca, Laurie Administrator - Hospital Operations 3162685161	Labarca, Laurie Administrator - Hospital Operations Via Christi Hospitals Wichita, Inc. 3162685161	10/23/2017 10:57 PM
Contacts	Signed By	Update		Labarca, Laurie Administrator - Hospital Operations 3162685161	Labarca, Laurie Administrator - Hospital Operations Via Christi Hospitals Wichita, Inc. 3162685161	10/23/2017 10:57 PM
Contacts	Authorizing Official	Insert			Labarca, Laurie Administrator - Hospital Operations 3162685161	8/1/2017 2:29 PM
Contacts	Signed By	Insert			Labarca, Laurie Administrator - Hospital Operations 3162685161	8/1/2017 2:29 PM
Addresses	Main Address	Insert			1121 S CLIFTON AVE WICHITA, KS 67218-2912	7/12/2017 3:57 PM
Addresses	Shipping Address	Insert			Via Christi Hospital Pharmacy Department 929 N. St. Francis Wichita, KS 67214	7/12/2017 3:57 PM
Contacts	Primary Contact	Insert			Garrelts, Jim Senior Director of Pharmacy 3162685580	7/12/2017 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Number	Insert			100080640B	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: State	Insert			KS	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Number	Insert			100080640D	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: State	Insert			KS	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Number	Insert			100695200A	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: State	Insert			OK	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: Number	Insert			100695200I	5/24/2017 9:29 AM
Medicaid Billing	Medicaid: State	Insert			OK	5/24/2017 9:29 AM
Medicaid Billing	NPI: Number	Insert			1154314789	5/24/2017 9:29 AM
Medicaid Billing	NPI: Number	Insert			1871589333	5/24/2017 9:29 AM
Dates	Participating Approval Date	Update			11/15/2016 12:00:00 AM	11/15/2016 3:31 PM
Details	State	Update		Pending	Active	11/15/2016 3:31 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/15/2016 3:31 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72453	DSH170122Y	11/15/2016 12:54 PM
Details	Entity Subname	Update		VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic – SJ	VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic	11/15/2016 12:54 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72453	10/5/2016 12:37 PM
Details	Last Recertification Date	Insert				10/5/2016 12:37 PM
Details	Grant Number	Insert				10/5/2016 12:37 PM
Details	340B ID	Insert				10/5/2016 12:37 PM
Details	Is Authorizing Official EHB Data	Insert				10/5/2016 12:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/5/2016 12:37 PM
Details	Medicare Provider Number	Insert			170122	10/5/2016 12:37 PM
Details	Entity Name	Insert			VIA CHRISTI HOSPITAL WICHITA	10/5/2016 12:37 PM
Details	Program Code	Insert			DSH	10/5/2016 12:37 PM
Details	Entity Subname	Insert			VIA CHRISTI HOSPITALS WICHITA, INC. / Family Practice Clinic – SJ	10/5/2016 12:37 PM
Dates	Participating Approval Date	Insert				10/5/2016 12:37 PM
Details	State	Insert			Pending	10/5/2016 12:37 PM
Dates	Registration Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 12:37 PM
Dates	Signed By Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 12:37 PM
Dates	Start Date	Insert				10/5/2016 12:37 PM
Terminations	Termination Comments	Insert				10/5/2016 12:37 PM
Terminations	Termination Date	Insert				10/5/2016 12:37 PM
Terminations	Termination Effective Date	Insert				10/5/2016 12:37 PM
Terminations	Termination Reason	Insert				10/5/2016 12:37 PM