Covered Entity Details

DSH390006AP GEISINGER MEDICAL CENTER (Active) - information as of 4/26/2025 11:41:14 PM

Main Details

Name

GEISINGER MEDICAL CENTER

Subdivision Name

GEISINGER MEDICAL CENTER / Emergency Room GSACH

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390006AP

Medicare Provider Number

390006

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/3/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/9/2017

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Geisinger Health
Michael Anthony Evans, VP Pharmacy CPO
(570) 271-6192

Primary Contact

Geisinger Health
Lola Travelpiece, 340B Program Manager
(570) 214-1035

Addresses

Street Address

4200 HOSPITAL RD
G-SACH
COAL TOWNSHIP, PA 17866-9668

Billing Address

Geisinger Medical Center
100 North Academy Ave
Danville, PA 17822

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
PA	1007478860100,1007478860102,1007478860091,1007478860092,1007478860097,1007478860094,1007478860060,1007478860093,1007478860052,1007478860069,1007478860110,1007478860067,1007478860086,1007478860063,1007478860095,1007478860087,1007478860089,1007478860088,1007478860096,1007478860105,1007478860108,1007478860109,1007478860050,1007478860098,1007478860107,1007478860090	1003170937,1790128254,1154617694,1427344969,1033491741,1063708501,1417231937,1669768289,1063540011,1144301102,1235215427,1528197720,1538391248,1962583922,1770879215,1275850620,1275832164,1457650343,1518281039,1659762862,1245632231,1982037966,1013384809,1801831326,1093555120,1104682061,1467748475

Shipping Addresses

Shipping Address 1

Geisinger Medical Center
100 North Academy Ave
Danville, PA 17822

Shipping Address 2

Geisinger System Services Distribution Center
212 Industrial Park Rd
Elysburg, PA 17824

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
DSH390006A	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center Cancer Center Hazleton	1740 East Broad St	Hazleton	PA	Active
DSH390006AA	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center SELINSGROVE SPECIALTIES OB GYN	620 University Avenue	Selinsgrove	PA	Active
DSH390006AB	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Oncology - Lewisburg	75 Medical Park Dr	Lewisburg	PA	Active
DSH390006AC	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger-Shamokin Opthalmology AMB Care FAC	4203 Hospital Road	Coal Township	PA	Active
DSH390006AD	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Autism and Developmental Medicine / Psychiatry Autism ACC Lewisburg	120 Hamm Drive, 2nd floor	Lewisburg	PA	Active
DSH390006AE	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Autism and Developmental Medicine / Peds Neurodevelopement Lewisburg ACC	120 Hamm Drive, 2nd floor	Lewisburg	PA	Active
DSH390006AF	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin / Orthopedics ACC SACH	4203 Hospital Road	Coal Township	PA	Terminated
DSH390006AG	Child	DSH	GEISINGER MEDICAL CENTER	Hematol Oncol ACC Selinsgrove	1575 N Old Trail	Selinsgrove	PA	Active
DSH390006AH	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - WOODBINE / OPHTHALMOLOGY AMB CARE FAC	16 WOODBINE LANE	DANVILLE	PA	Active
DSH390006AJ	Child	DSH	GEISINGER MEDICAL CENTER	WOODBINE CLINIC / Gen Pediatrics EJ Knapper	16 WOODBINE LANE	DANVILLE	PA	Active
DSH390006AK	Child	DSH	GEISINGER MEDICAL CENTER	Family Practice Woodbine	16 WOODBINE LANE	DANVILLE	PA	Active
DSH390006AL	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Anesthesia Hosp GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AM	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Operating Rooms GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AN	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Peri-OP GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AP	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Emergency Room GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AQ	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / In and Out Surgery GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AR	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / General Surgery GSACH	4203 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AS	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Transitional Care Unit GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AT	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / West 2 Med Surg GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AU	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Main 2 Med Surg GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AV	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER / Main2 Special Care Unit GSACH	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AW	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - Orthopedic ACC Central Rd	480 CENTRAL ROAD	BLOOMSBURG	PA	Active
DSH390006AX	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - Rheumatology Acc at Woodbine La	16 WOODBINE LANE	DANVILLE	PA	Active
DSH390006AY	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - Rheumatology at Shamokin	4200 HOSPITAL RD	COAL TOWNSHIP	PA	Active
DSH390006AZ	Child	DSH	GEISINGER MEDICAL CENTER	MRI Woodbine	16 Woodbine La	Danville	PA	Active
DSH390006B	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Lows Road Cardiology AMB Care Lows Rd	6850 Lows Road	Bloomsburg	PA	Active
DSH390006BA	Child	DSH	GEISINGER MEDICAL CENTER	Cat Scan - Woodbine	16 Woodbine La	Danville	PA	Terminated
DSH390006BB	Child	DSH	GEISINGER MEDICAL CENTER	GMC Radiology Selinsgrove - GMC Radiology Selinsgrove	620 University Ave	Selinsgrove	PA	Active
DSH390006BC	Child	DSH	GEISINGER MEDICAL CENTER	X-RAY at Woodbine	16 Woodbine La	Danville	PA	Active
DSH390006BD	Child	DSH	GEISINGER MEDICAL CENTER	GMC Selinsgrove MRI - GMC Selinsgrove MRI	620 University Ave	Selinsgrove	PA	Terminated
DSH390006BE	Child	DSH	GEISINGER MEDICAL CENTER	General Diagnostic Radiology Geisinger Shamokin Community Hospital - General Diagnostic Radiology Geisinger Shamokin Community Hospital	4200 Hospital Rd	Coal Township	PA	Terminated
DSH390006BF	Child	DSH	GEISINGER MEDICAL CENTER	Cat Scan Shamokin Area Community Hopsital - Cat Scan Shamokin Area Community Hopsital	4200 Hospital Rd	Coal Township	PA	Terminated
DSH390006BG	Child	DSH	GEISINGER MEDICAL CENTER	MRI Shamokin Area Community Hospital - MRI Shamokin Area Community Hospital	4200 Hospital Rd	Coal Township	PA	Terminated
DSH390006BH	Child	DSH	GEISINGER MEDICAL CENTER	GMC Selinsgrove Cat Scan - GMC Selinsgrove Cat Scan	620 University Ave	Selinsgrove	PA	Terminated
DSH390006BJ	Child	DSH	GEISINGER MEDICAL CENTER	Woodbine Surgery Center Orthopaedics Pediatrics Woodbine - Ortho Peds ACC Woodbine	16 WOODBINE LANE	Danville	PA	Active
DSH390006BK	Child	DSH	GEISINGER MEDICAL CENTER	Radiation Oncology acute care center Pottsville - Rad-oncology ACC Pottsville	1 East Norwegian Street	Pottsville	PA	Active
DSH390006BL	Child	DSH	GEISINGER MEDICAL CENTER	Peds Cardiology Acute Care Center Lows Rd - Peds Cardiology ACC Lows Rd	6850 Lows Rd	Bloomsburg	PA	Terminated
DSH390006BM	Child	DSH	GEISINGER MEDICAL CENTER	Podiatry Woodbine	16 WOODBINE LANE	Danville	PA	Active
DSH390006BN	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL ONCOLOGY LEWISBUR - Radiation Oncology ACC	75 MEDICAL PARK DRIVE	LEWISBURG	PA	Active
DSH390006BP	Child	DSH	GEISINGER MEDICAL CENTER	Ophthalmology Sunbury - Ophthalmology Sunbury	437 Market St	Sunbury	PA	Active
DSH390006BQ	Child	DSH	GEISINGER MEDICAL CENTER	Outpatient Surgery Woodbine La - Pain Medicine Ambulatory Care Facility	16 WOODBINE LANE	Danville	PA	Active
DSH390006BR	Child	DSH	GEISINGER MEDICAL CENTER	Outpatient Surgery at Woodbine La - Cosmetics Center Woodbine	16 WOODBINE LANE	Danville	PA	Active
DSH390006BS	Child	DSH	GEISINGER MEDICAL CENTER	CONTINOUS AMBULATORY PERITONEAL DIALYSIS - CONTIN AMB PERITONEAL DIALYSIS	32 Justin Dr	Danville	PA	Terminated
DSH390006BT	Child	DSH	GEISINGER MEDICAL CENTER	Specialties Services SACH - Pulmonary Medicine	4203 Hospital Rd	Coal Township	PA	Active
DSH390006BU	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Shamokin Area Community Hospital - Respiratory Therapy	4200 Hospital Rd	Coal Township	PA	Active
DSH390006BV	Child	DSH	GEISINGER MEDICAL CENTER	Clinic Services GSACH - Dermatology	4200 Hospital Rd	Coal Township	PA	Active
DSH390006BW	Child	DSH	GEISINGER MEDICAL CENTER	Clinic Services GSACH - Gastroenterology	4200 Hospital Rd	Coal Township	PA	Active
DSH390006BX	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - UROLOGY GSACH AMB CARE FAC	4203 HOSPITAL ROAD	COAL TOWNSHIP	PA	Active
DSH390006BY	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - ORTHO ACC ELYSBURG	436 W VALLEY AVE	ELYSBURG	PA	Active
DSH390006BZ	Child	DSH	GEISINGER MEDICAL CENTER	GEN SURG WOODBINE	16 WOODBINE LN	DANVILLE	PA	Active
DSH390006C	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Woodbine (Surgery Center) Dermatology AMB Care FAC	16 Woodbine Lane	Danville	PA	Active
DSH390006CA	Child	DSH	GEISINGER MEDICAL CENTER	PEDS ADOLESCENT MED WOODBINE - ADOLESCENT MEDICINE	16 WOODBINE LN	DANVILLE	PA	Active
DSH390006CB	Child	DSH	GEISINGER MEDICAL CENTER	ORTHO SPINE SURGERY WOODBINE - ORTHO SPINE SURGERY	16 WOODBINE LN	DANVILLE	PA	Active
DSH390006CC	Child	DSH	GEISINGER MEDICAL CENTER	WOUND CARE ELYSBURG - ORTHOPEDICS	436 W VALLEY AVE	ELYSBURG	PA	Active
DSH390006CD	Child	DSH	GEISINGER MEDICAL CENTER	General Internal Med Woodbine - General Internal Medicine	16 WOODBINE LN	DANVILLE	PA	Active
DSH390006CE	Child	DSH	GEISINGER MEDICAL CENTER	OTOLARYNGOLOGY ALLERGY WOODBINE - OTOLARYNGOLOGY	16 WOODBINE LN	DANVILLE	PA	Active
DSH390006CF	Child	DSH	GEISINGER MEDICAL CENTER	CARDIAC STUDIES JPM ROAD LEWISBURG - ECHOCARDIOGRAPH	131 JPM Road	LEWISBURG	PA	Active
DSH390006CG	Child	DSH	GEISINGER MEDICAL CENTER	GSACH - Cardiac Studies GSACH	4200 Hospital Rd	Coal Township	PA	Active
DSH390006CH	Child	DSH	GEISINGER MEDICAL CENTER	Woodbine - Interventional Pain CTR Woodbine	16 Woodbine Lane	Danville	PA	Terminated
DSH390006CJ	Child	DSH	GEISINGER MEDICAL CENTER	GSACH - GSACH MR Imaging	4200 Hospital Rd	Coal Township	PA	Active
DSH390006CK	Child	DSH	GEISINGER MEDICAL CENTER	SVI - SVI Lewisburg XR Imaging	120 Hamm Drive	Lewisburg	PA	Active
DSH390006CL	Child	DSH	GEISINGER MEDICAL CENTER	SVI - SVI Lewisburg MR Imaging	120 Hamm Drive	Lewisburg	PA	Active
DSH390006CM	Child	DSH	GEISINGER MEDICAL CENTER	GSACH - GSACH CT Imaging	4200 Hospital Rd	Coal Township	PA	Active
DSH390006CN	Child	DSH	GEISINGER MEDICAL CENTER	Woodbine - Woodbine CT Imagine	16 Woodbine Lane	Danville	PA	Active
DSH390006CP	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - SVI Lewisburg CT Imaging	120 Hamm Drive	Lewisburg	PA	Active
DSH390006CQ	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Outpatient Adult Neurology	35 Justin Drive	Danville	PA	Active
DSH390006CR	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - BH Outpatient ACC GMC	9 Stearns Lane	Danville	PA	Active
DSH390006CS	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Endocrinology	35 Justin Drive	Danville	PA	Active
DSH390006CT	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Neurophysiology	35 Justin Drive	Danville	PA	Active
DSH390006CU	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - General Internal Medicine	35 Justin Drive	Danville	PA	Active
DSH390006CV	Child	DSH	GEISINGER MEDICAL CENTER	OSW - Outpatient Surgery Woodbine	16 Woodbine Lane	Danville	PA	Active
DSH390006CW	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Clinic Nutrition Services GSACH	4203 Hospital Road	Coal Township	PA	Active
DSH390006CX	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Sleep Disorder Center Woodbine	44 Woodbine Lane	Danville	PA	Active
DSH390006CY	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Sleep Disorder Center GSACH	4203 Hospital Road	Coal Township	PA	Active
DSH390006CZ	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Cardiac Rehab GSACH	4200 Hospital Rd	Coal Township	PA	Active
DSH390006D	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Orthopedics ACC Woodbine	16 Woodbine Lane	Danville	PA	Active
DSH390006DA	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center - Gen Internal Med ACC	100 North Academy Ave	Danville	PA	Active
DSH390006DB	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - GSACH General Radiology	4203 HOSPITAL ROAD	COAL TOWNSHIP	PA	Active
DSH390006DC	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - General Radiology Central Road Bloomsburg	480 CENTRAL ROAD	BLOOMSBURG	PA	Active
DSH390006DD	Child	DSH	GEISINGER MEDICAL CENTER	GEISINGER MEDICAL CENTER - General Radiology Elysburg	436 W VALLEY AVE	ELYSBURG	PA	Active
DSH390006E	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center Heart and Vascular Institute Lewisburg - Cardiovasc Med Lewisburg ACC	131 JPM Road	Lewisburg	PA	Active
DSH390006F	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center Dermatology AMB Care FAC	620 University Avenue	Selinsgrove	PA	Active
DSH390006G	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center Endocrinology AMB Care FAC	620 University Avenue	Selinsgrove	PA	Terminated
DSH390006H	Child	DSH	GEISINGER MEDICAL CENTER	Nephrology Selinsgrove	620 University Avenue	Selinsgrove	PA	Active
DSH390006J	Child	DSH	GEISINGER MEDICAL CENTER	Neurology Selinsgrove	620 University Avenue	Selinsgrove	PA	Active
DSH390006K	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center Rheumatology AMB Care FAC	620 University Avenue	Selinsgrove	PA	Active
DSH390006L	Child	DSH	GEISINGER MEDICAL CENTER	General Pediatrics Selinsgrove	620 University Avenue	Selinsgrove	PA	Active
DSH390006M	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center Hematology Oncology AMB Care	4203 Hospital Road	Coal Township	PA	Terminated
DSH390006N	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center Nephrology AMB Care FAC	4200 Hospital Road	Coal Township	PA	Active
DSH390006P	Child	DSH	GEISINGER MEDICAL CENTER	General Surgery-Shamokin	4203 Hospital Road	Coal Township	PA	Active
DSH390006Q	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center Urogynecology AMB Care FAC	4203 Hospital Road	Coal Township	PA	Terminated
DSH390006R	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center Outpatient Dialysis Unit Justin Drive	32 Justin Drive	Danville	PA	Active
DSH390006S	Child	DSH	GEISINGER MEDICAL CENTER	Gynecology/Obstetrics Shamokin	4203 Hospital Road	Coal Township	PA	Active
DSH390006T	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Center Woodbine (HBC)	16 Woodbine Lane	Danville	PA	Terminated
DSH390006U	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger Medical Oncology - Pottsville, a service of Geisinger Medical Center Hematol Oncol ACC Pottsville	1 East Norwegian Street	Pottsville	PA	Active
DSH390006V	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center ORTHOPEDICS ACC SACH	4200 Hospital Rd.	Coal Township	PA	Active
DSH390006W	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center SPECIALTIES SVCS SACH	4203 Hospital Rd	Coal Township	PA	Active
DSH390006X	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Shamokin, a service of Geisinger Medical Center GEN PEDIATRICS ACC SACH	4200 Hospital Road	Coal Township	PA	Active
DSH390006Y	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center SPECIALTY SVCS SELINSGROVE	620 University Ave	Selinsgrove	PA	Terminated
DSH390006Z	Child	DSH	GEISINGER MEDICAL CENTER	Geisinger - Susquehanna University, Geisinger Medical Center ORTHO ACC SELINSGROVE	620 University Ave	Selinsgrove	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Brosious, Megan M Chief Administrative Officer Geisinger Medical Center 5702718892	Evans, Michael Anthony VP Pharmacy CPO Geisinger Health 5702716192	3/13/2025 8:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	12/17/2024 7:23 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007478860090	12/17/2024 7:23 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	12/17/2024 7:23 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1467748475	12/17/2024 7:23 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	12/17/2024 7:23 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860090 (PA)		8/29/2024 11:48 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860065 (PA)		8/29/2024 11:48 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1467748475 (PA)		8/29/2024 11:48 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1851508162 (PA)		8/29/2024 11:48 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1124389655 (PA)		8/29/2024 11:48 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1093555120	8/29/2024 11:48 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/29/2024 11:48 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104682061	8/29/2024 11:48 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/29/2024 11:48 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 4:38:51 PM	8/29/2024 11:48:57 AM	8/29/2024 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/6/2023 4:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860107	9/6/2023 4:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/6/2023 4:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1841551371 (PA)		9/6/2023 4:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1801418306 (PA)		9/6/2023 4:38 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 7:50:33 AM	9/6/2023 4:38:51 PM	9/6/2023 4:38 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1007478860007 (PA)		6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1007478860107 (PA)		6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1007478860101 (PA)		6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007478860050	6/13/2023 3:22 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/13/2023 3:22 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007478860098	6/13/2023 3:22 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	6/13/2023 3:22 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1215202809 (PA)		6/13/2023 3:22 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1801831326	6/13/2023 3:22 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/13/2023 3:22 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1801418306	6/13/2023 3:22 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/13/2023 3:22 PM
Contacts	Primary Contact	Update	Profile Change Request	Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035	Travelpiece, Lola 340B Program Manager Geisinger Health 5702141035	9/26/2022 9:58 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860098 (PA)		9/13/2022 7:50 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860050 (PA)		9/13/2022 7:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/13/2022 7:50 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860065	9/13/2022 7:50 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/13/2022 7:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/13/2022 7:50 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860101	9/13/2022 7:50 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/13/2022 7:50 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801418306 (PA)		9/13/2022 7:50 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801831326 (PA)		9/13/2022 7:50 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 7:54:01 AM	9/13/2022 7:50:33 AM	9/13/2022 7:50 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 8:33:38 AM	8/16/2021 7:54:01 AM	8/16/2021 7:54 AM
Contacts	Authorizing Official	Update	Change Request	Sokola, Thomas P. Chief Administrative Officer Geisinger 5702718892	Brosious, Megan M Chief Administrative Officer Geisinger Medical Center 5702718892	3/26/2021 2:57 PM
Addresses	Shipping Address	Insert	Recertification		Geisinger System Services Distribution Center 212 Industrial Park Rd Elysburg, PA 17824	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860100 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860007 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860090 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860101 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860091 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860097 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860098 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860060 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860110 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860067 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860086 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860063 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860095 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860087 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860089 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860088 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860105 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860107 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860108 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860109 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860092 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860009 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860094 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860008 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860093 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860005 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	413070 (NY)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	4185901 (NJ)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3088508 (CT)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0363735 (OH)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860102 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860100	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860007	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860090	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860102	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860091	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860092	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860097	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860098	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860094	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860060	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860093	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860052	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860069	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860110	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860067	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860086	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860063	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860095	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860087	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860089	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860088	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860096	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860105	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860107	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860108	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860109	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007478860050	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860069 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860050 (PA)		9/10/2020 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007478860051 (PA)		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1790128254 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1003170937	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215202809	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467748475	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790128254	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1154617694	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1427344969	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1033491741	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1063708501	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1417231937	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1669768289	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1063540011	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1144301102	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1235215427	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1528197720	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1538391248	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1851508162	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1962583922	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1770879215	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801418306	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1275850620	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1275832164	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1841551371	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1457650343	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1124389655	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1518281039	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1659762862	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1245632231	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1982037966	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1013384809	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1801831326	9/10/2020 8:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1801831326 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1942246038 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1003170937 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1013173970 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1013384809 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1033491741 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1063708501 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1063796522 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114265030 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1124389655 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1144301102 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1154617694 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1215202809 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1235215427 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1245632231 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1275832164 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1275850620 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1427344969 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1457650343 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1467748475 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1497913388 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1528197720 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1528519006 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1538391248 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659762862 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1770879215 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1841551371 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1851508162 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1962583922 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982037966 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1982988408 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1518281039 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669768289 ( )		9/10/2020 8:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1568414928 ( )		9/10/2020 8:33 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 5:07:24 PM	9/10/2020 8:33:38 AM	9/10/2020 8:33 AM
Contacts	Primary Contact	Update	Change Request	Guschel, Timothy 340B Program Director Geisinger Health 5702140155	Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035	6/3/2020 8:34 AM
Details	Last Recertification Date	Update	Recertification	8/20/2018 6:27:10 PM	8/26/2019 5:07:24 PM	8/26/2019 5:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/9/2019 4:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860102	7/9/2019 4:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	7/9/2019 4:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007478860092 (PA)		7/1/2019 12:27 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007478860086 (PA)		7/1/2019 12:27 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007478860095 (PA)		7/1/2019 12:27 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	363735	0363735	7/1/2019 12:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790128254	7/1/2019 12:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801831326 ( )		7/1/2019 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		413070	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4185901	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3088508	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		363735	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	12/20/2018 10:29 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1568414928	12/20/2018 10:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860100	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860007	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860090	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860101	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860091	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860092	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860097	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860098	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860060	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860110	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860067	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860086	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860063	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860095	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860087	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860089	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860088	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860105	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860107	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860108	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860109	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860092	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860009	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860094	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860086	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860008	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860095	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860093	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007478860005	11/19/2018 9:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1992824874 ( )		11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1003170937	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1013173970	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1013384809	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1033491741	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063708501	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063796522	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1114265030	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1124389655	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1144301102	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1154617694	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215202809	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1235215427	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1245632231	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1275832164	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1275850620	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1427344969	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1457650343	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467748475	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1497913388	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1528197720	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1528519006	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1538391248	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1659762862	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770879215	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841551371	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1851508162	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1962583922	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1982037966	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1982988408	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1518281039	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1669768289	11/19/2018 9:30 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1801831326	11/19/2018 9:30 AM
Details	Last Recertification Date	Update	Recertification	11/13/2017 7:27:10 AM	8/20/2018 6:27:10 PM	8/20/2018 6:27 PM
Contacts	Primary Contact	Update	Profile Change Request	Guschel, Timothy 340B Program Director Geisinger Health System 5702140155	Guschel, Timothy 340B Program Director Geisinger Health 5702140155	6/28/2018 10:45 AM
Details	Last Recertification Date	Update	Recertification		11/13/2017 7:27:10 AM	11/13/2017 7:27 AM
Contacts	Primary Contact	Update	Profile Change Request	Guschel, TImothy 340B Program Director Geisinger Health System 5702140155	Guschel, Timothy 340B Program Director Geisinger Health System 5702140155	10/5/2017 12:11 PM
Contacts	Authorizing Official	Update		Sokola, Thomas P. Chief Administrative Officer 5702718892	Sokola, Thomas P. Chief Administrative Officer Geisinger 5702718892	9/26/2017 1:06 PM
Contacts	Signed By	Update		Sokola, Thomas P. Chief Administrative Officer 5702718892	Sokola, Thomas P. Chief Administrative Officer Geisinger 5702718892	9/26/2017 1:06 PM
Contacts	Primary Contact	Update		Guschel, TImothy 340B Program Director 5702140155	Guschel, TImothy 340B Program Director Geisinger Health System 5702140155	9/18/2017 4:18 PM
Contacts	Primary Contact	Insert			Guschel, TImothy 340B Program Director 5702140155	7/6/2017 9:17 AM
Contacts	Authorizing Official	Insert			Sokola, Thomas P. Chief Administrative Officer 5702718892	7/6/2017 9:17 AM
Contacts	Signed By	Insert			Sokola, Thomas P. Chief Administrative Officer 5702718892	7/6/2017 9:17 AM
Addresses	Main Address	Insert			4200 HOSPITAL RD G-SACH COAL TOWNSHIP, PA 17866-9668	1/9/2017 4:05 PM
Addresses	Billing Address	Insert			Geisinger Medical Center 100 North Academy Ave Danville, PA 17822	1/9/2017 4:05 PM
Addresses	Shipping Address	Insert			Geisinger Medical Center 100 North Academy Ave Danville, PA 17822	1/9/2017 4:05 PM
Dates	Participating Approval Date	Update			1/9/2017 12:00:00 AM	1/9/2017 4:01 PM
Details	State	Update		Pending	Active	1/9/2017 4:01 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	1/9/2017 4:01 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73666	DSH390006AP	1/3/2017 1:54 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73666	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			1007478860069	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: State	Insert			PA	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			1007478860050	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: State	Insert			PA	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			1007478860051	1/3/2017 1:19 PM
Medicaid Billing	Medicaid: State	Insert			PA	1/3/2017 1:19 PM
Medicaid Billing	NPI: Number	Insert			1801831326	1/3/2017 1:19 PM
Medicaid Billing	NPI: Number	Insert			1942246038	1/3/2017 1:19 PM
Medicaid Billing	NPI: Number	Insert			1992824874	1/3/2017 1:19 PM
Details	Last Recertification Date	Insert				1/3/2017 1:19 PM
Details	Grant Number	Insert				1/3/2017 1:19 PM
Details	340B ID	Insert				1/3/2017 1:19 PM
Details	Is Authorizing Official EHB Data	Insert				1/3/2017 1:19 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/3/2017 1:19 PM
Details	Medicare Provider Number	Insert			390006	1/3/2017 1:19 PM
Details	Entity Name	Insert			GEISINGER MEDICAL CENTER	1/3/2017 1:19 PM
Details	Program Code	Insert			DSH	1/3/2017 1:19 PM
Details	Entity Subname	Insert			GEISINGER MEDICAL CENTER / Emergency Room GSACH	1/3/2017 1:19 PM
Dates	Participating Approval Date	Insert				1/3/2017 1:19 PM
Details	State	Insert			Pending	1/3/2017 1:19 PM
Dates	Registration Date	Insert			1/3/2017 12:00:00 AM	1/3/2017 1:19 PM
Dates	Signed By Date	Insert			1/3/2017 12:00:00 AM	1/3/2017 1:19 PM
Dates	Start Date	Insert				1/3/2017 1:19 PM
Terminations	Termination Comments	Insert				1/3/2017 1:19 PM
Terminations	Termination Date	Insert				1/3/2017 1:19 PM
Terminations	Termination Effective Date	Insert				1/3/2017 1:19 PM
Terminations	Termination Reason	Insert				1/3/2017 1:19 PM