Covered Entity Details

DSH030014U HONORHEALTH JOHN C. LINCOLN MED CTR (Terminated) - information as of 6/12/2025 9:44:30 PM

Main Details

Name

HONORHEALTH JOHN C. LINCOLN MED CTR

Subdivision Name

Virginia G Piper Cancer Care Network-Wickenburg

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030014U

Medicare Provider Number

030014

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/3/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/11/2018

Last Recertification Date

8/24/2021

Termination Date
Termination Reason

10/1/2021
Business decision by the Covered Entity

Contacts

Authorizing Official

HonorHealth
Gary Baker, SVP-CEO-HOSPITAL
(480) 583-0803

Primary Contact

HonorHealth
Kristjon Lindgren, 340B Program Director
(602) 793-5509

Addresses

Street Address

519 Rose Ln
Wickenburg, AZ 85390

Billing Address

HONORHEALTH JOHN C. LINCOLN MED CTR
PO Box 14890
Scottsdale, AZ 85267

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
AK	HS757IP,HS757OP	1770690695
AL	JOH0014N	1770690695
AR	189215105	1770690695
CA	90367,860181654,XHSP42340,XHSP32340,1386608859,860181654WV,PRV006826,QMP000004946960	1770690695
CO	95190112,860181654,9000195815	1770690695
CT	003054129,008047201	1770690695
DC	055575200	1770690695
FL	092474100,245412000,860117301,ND895,1326503	1770690695
GA	003176592A,003116091A,000487946X,NR - REVAL,003176648A,860181654,N1425	1770690695
IA	02885297,0983767,1983767	1770690695
ID	002925100	1770690695
IL	N1425,860181654,860181654006,860117301001	1770690695
IN	860181654,201035820A,300042446	1770690695
KS	02885297,100100590C,860181654	1770690695
KY	01220136,0122013600,ND895,N1425,N1098839	1770690695
LA	60065488,10025901,1749982	1770690695
MA	0964397,35974,110027159A,110027159B	1770690695
MD	02885297,70025901,488644,860181654,531209400	1770690695
ME	191160000	1770690695
MI	860181654,860117301,30-4908703,40-4908712	1770690695
MN	00500080007,447317500,300969,860181654	1770690695
MO	011380201,N1425	1770690695
MS	01074063	1770690695
NC	9300014	1770690695
NE	10026210700	1770690695
NJ	02885297,10025901,60159345	1770690695
NM	860181654,01201026,201080235,24051837	1770690695
NV	001188961,02885297	1770690695
NY	488644,111031000122,860181654,01619396	1770690695
OH	860181654,860117301001,6921880,5187257,860181654D	1770690695
OK	100704870A	1770690695
OR	128579,860117301,860181654	1770690695
PA	30245244,1007457650007,1007632800001,43957,VC9417	1770690695
SC	12148B,11680A	1770690695
TN	02885297,0012108,Q013661,0030014	1770690695
TX	02885297,071480001,QMP000005075548	1770690695
UT	1023425,QMP000003687930	1770690695
VA	860181654	1770690695
VT	0030014	1770690695
WA	02885297,151234,1018702,QMP000004937946	1770690695
WI	100056786,80517700,03996805,100102520	1770690695
WV	860181654,9810047000	1770690695
HI	860181654	1770690695
AZ	022241	1770690695
DE		1770690695
WY		1770690695
MT		1770690695
RI		1770690695

Shipping Addresses

Same as Street Address

Contract Pharmacies

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

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH030014A	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	Outpatient / Medical Imaging	9250 N 3rd St #1002	Phoenix	AZ	Terminated
DSH030014AA	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Wound Clinic OP	9202 N 2nd St #101	Phoenix	AZ	Active
DSH030014AB	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Pulmonary Hypertension Clinic	9250 N 3rd St #2030	Phoenix	AZ	Active
DSH030014AC	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Virginia G Piper CCN-Apache Junction	750 S Ironwood Dr #102	Apache Junction	AZ	Terminated
DSH030014AD	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Biltmore	2222 E Highland Ave #400	Phoenix	AZ	Active
DSH030014AE	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Tempe	7695 S Research Dr	Tempe	AZ	Active
DSH030014AF	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - GynOnc Shea	10197 N 92nd St #101	Scottsdale	AZ	Active
DSH030014AG	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	BMT Outpatient	10460 N 92nd St #300	Scottsdale	AZ	Active
DSH030014AH	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HHRI Oncology Clinical Trials	10510 N 92nd St	Scottsdale	AZ	Active
DSH030014AJ	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Home Health	3634 N Drinkwater Blvd	Scottsdale	AZ	Active
DSH030014B	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	John C Lincoln Outpatient Imaging - 27th Ave. / Medical Imaging	19636 N 27th Ave. #LL1	Phoenix	AZ	Terminated
DSH030014C	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	OR Outpatient Surgery	9250 N 3rd St #1001	Phoenix	AZ	Active
DSH030014D	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	John C Lincoln-Tatum / Outpatient Medical Imaging	18404 N Tatum Blvd. #103	Phoenix	AZ	Terminated
DSH030014E	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Infusion Center-Glendale	6220 W Bell Rd #110	Glendale	AZ	Active
DSH030014F	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	Pharmacy Care Coordination	9109 North Central Avenue	Phoenix	AZ	Terminated
DSH030014G	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	Comprehensive Care Clinic / Outpatient Center	9225 North 3rd Street	Phoenix	AZ	Terminated
DSH030014H	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	Comprehensive Care Center / Senior Support Services	9225 N 3rd St	Phoenix	AZ	Terminated
DSH030014J	Child	DSH	JOHN C LINCOLN MEDICAL CENTER	Happy Valley Infusion Care Clinic	10230 W. Happy Valley Parkway	Peoria	AZ	Terminated
DSH030014K	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - John C. Lincoln	9250 N 3rd St #3010	Phoenix	AZ	Active
DSH030014L	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Deer Valley	19646 N 27th Ave #301	Phoenix	AZ	Active
DSH030014M	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	OR Preop/PACU - OP	9250 N 3rd St #1001	Phoenix	AZ	Active
DSH030014N	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Osborn	3621 N Wells Fargo Ave	Scottsdale	AZ	Active
DSH030014P	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Gilbert	3645 S Rome St #209	Gilbert	AZ	Active
DSH030014Q	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Chandler	1110 S Dobson Rd #1	Chandler	AZ	Active
DSH030014R	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Thompson Peak	20745 N Scottsdale Rd #115	Scottsdale	AZ	Active
DSH030014S	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Avondale	10320 W McDowell Rd Bldg H	Avondale	AZ	Active
DSH030014T	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Surprise	14674 W Mountain View Blvd #105	Surprise	AZ	Active
DSH030014U	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Virginia G Piper Cancer Care Network-Wickenburg	519 Rose Ln	Wickenburg	AZ	Terminated
DSH030014V	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Fountain Hills	16716 E Palisades Blvd #103	Fountain Hills	AZ	Active
DSH030014W	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Glendale	15000 N 83rd Ave #300	Peoria	AZ	Active
DSH030014X	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	HonorHealth Cancer Care - Shea	10460 N 92nd St #200 and #400	Scottsdale	AZ	Active
DSH030014Y	Child	DSH	JOHN C. LINCOLN MEDICAL CENTER	JCLMC Infusion Center	3501 N Scottsdale Rd #136	Scottsdale	AZ	Terminated
DSH030014Z	Child	DSH	HONORHEALTH JOHN C. LINCOLN MED CTR	Infusion Center - NSI	7242 E Osborn Rd #340, #400, and #500	Scottsdale	AZ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Lindgren, Kristjon 340B Program Manager HonorHealth 6027935509	Lindgren, Kristjon 340B Program Director HonorHealth 6027935509	9/10/2022 7:07 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/13/2021 12:00:00 AM	9/17/2021 4:29 PM
Details	State	Update	Termination Request	Active	To Be Terminated	9/17/2021 4:29 PM
Terminations	Termination Date	Update	Termination Request		10/1/2021 12:00:00 AM	9/17/2021 4:29 PM
Terminations	Termination Effective Date	Update	Termination Request		9/13/2021 12:00:00 AM	9/17/2021 4:29 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	9/17/2021 4:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/9/2021 9:07 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		9000195815	9/9/2021 9:07 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		CO	9/9/2021 9:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/9/2021 9:07 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		11680A	9/9/2021 9:07 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		SC	9/9/2021 9:07 PM
Details	Entity Name	Update	Recertification	JOHN C. LINCOLN MEDICAL CENTER	HONORHEALTH JOHN C. LINCOLN MED CTR	8/25/2021 1:50 PM
Addresses	Billing Address	Update	Recertification	JOHN C. LINCOLN MEDICAL CENTER PO Box 14890 Scottsdale, AZ 85267	HONORHEALTH JOHN C. LINCOLN MED CTR PO Box 14890 Scottsdale, AZ 85267	8/24/2021 7:25 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 10:34:24 PM	8/24/2021 7:25:21 PM	8/24/2021 7:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/15/2021 12:43 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	6/15/2021 12:43 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	6/15/2021 12:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1326503	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1983767	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100102520	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	3/15/2021 7:14 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	QMP0000049379 (WA)		12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300042446	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		VC9417	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP000004937946	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	12/15/2020 7:11 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	QMP0000049469 (CA)		9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	QMP0000050755 (TX)		9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	QMP0000036879 (UT)		9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP000004946960	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		HI	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP000005075548	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP000003687930	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		03996805	9/15/2020 12:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	9/15/2020 12:00 AM
Details	Entity Name	Update	Recertification	JOHN C LINCOLN MEDICAL CENTER	JOHN C. LINCOLN MEDICAL CENTER	8/21/2020 11:25 AM
Addresses	Billing Address	Update	Recertification	JOHN C LINCOLN MEDICAL CENTER 250 E Dunlap Ave Phoenix, AZ 85020	JOHN C. LINCOLN MEDICAL CENTER PO Box 14890 Scottsdale, AZ 85267	8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (AK)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (AL)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (AR)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (CA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (CO)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (DE)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (FL)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (GA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (HI)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (IA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (ID)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (IL)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (IN)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (KS)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (KY)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (LA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MD)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (ME)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MI)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MN)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MO)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MS)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (MT)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NC)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NE)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NJ)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NM)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NV)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (NY)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (OH)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (OR)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (PA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (RI)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (TN)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (TX)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (UT)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (VA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (WA)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (WI)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (WV)		8/20/2020 10:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1770690695 (WY)		8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NV	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		DC	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		DE	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		HI	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770690695	8/20/2020 10:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	8/20/2020 10:34 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1770690695 ( )		8/20/2020 10:34 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 12:15:09 PM	8/20/2020 10:34:24 PM	8/20/2020 10:34 PM
Contacts	Primary Contact	Update	Profile Change Request	Lindgren, Kristjon 340B Program Manager HonorHealth 6028706060-331353	Lindgren, Kristjon 340B Program Manager HonorHealth 6027935509	8/18/2020 10:18 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	860181654 (CO)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	008047201 (CT)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	092474100 (FL)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003176592A (GA)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (IA)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (ID)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	860181654006 (IL)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	201035820A (IN)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (MI)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (MN)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	128579 (OR)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007457650007 (PA)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	12148B (SC)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003054129 (CT)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (NC)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (NV)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1023425 (UT)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1770690695 (ME)		5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		HS757IP	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		HS757OP	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		JOH0014N	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		189215105	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		90367	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP42340	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP32340	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1386608859	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654WV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		PRV006826	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP0000049469	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		95190112	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003054129	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008047201	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		055575200	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DE	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		092474100	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		245412000	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860117301	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		ND895	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003176592A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003116091A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000487946X	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		NR - REVAL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003176648A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		N1425	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		HI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0983767	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		002925100	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		N1425	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654006	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860117301001	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		201035820A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100100590C	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01220136	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0122013600	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		ND895	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		N1425	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		60065488	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10025901	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1749982	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0964397	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		35974	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110027159A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110027159B	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		70025901	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		488644	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		531209400	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		191160000	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860117301	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30-4908703	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		40-4908712	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00500080007	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		447317500	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300969	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		011380201	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		N1425	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01074063	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9300014	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10026210700	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10025901	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		60159345	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01201026	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		201080235	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		001188961	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		488644	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		111031000122	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01619396	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860117301001	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		6921880	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		5187257	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654D	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100704870A	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OK	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		128579	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860117301	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30245244	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007457650007	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007632800001	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		RI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		12148B	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0012108	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q013661	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0030014	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP0000050755	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		071480001	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1023425	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0030014	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02885297	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		151234	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP0000049379	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1018702	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100056786	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		80517700	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9810047000	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		N1098839	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		24051837	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		43957	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		QMP0000036879	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	5/30/2020 8:40 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	3054129	003054129	9/12/2019 4:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/12/2019 4:28 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	9/12/2019 4:28 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	9/12/2019 4:28 PM
Details	Entity Subname	Update	Change Request	Virginia G Piper Cancer Care Network-Wickenburg - Virginia G Piper Cancer Care Network-Wickenburg	Virginia G Piper Cancer Care Network-Wickenburg	9/12/2019 4:28 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 7:57:54 AM	9/5/2019 12:15:09 PM	9/5/2019 12:15 PM
Contacts	Authorizing Official	Update	AO Change Request	Post, Kim EVP Chief Operations Officer HonorHealth 4805875087	Baker, Gary SVP-CEO-HOSPITAL HonorHealth 4805830803	8/26/2019 6:42 AM
Contacts	Primary Contact	Update	Change Request	Lindgren, Kristjon 340B Program Manager HonorHealth 6028706060-331353	Lindgren, Kristjon 340B Program Manager HonorHealth 6028706060-331353	8/2/2019 8:57 AM
Contacts	Authorizing Official	Update	Profile Change Request	Post, Kim SVP-CEO HOS_CHF CLIN OFC HonorHealth 4805875087	Post, Kim EVP Chief Operations Officer HonorHealth 4805875087	7/19/2019 12:28 PM
Contacts	Authorizing Official	Update	Change Request	Pope, Alice Chief Financial Officer HonorHealth 4808825544	Post, Kim SVP-CEO HOS_CHF CLIN OFC HonorHealth 4805875087	7/1/2019 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3054129	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1023425	6/14/2019 11:23 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	6/14/2019 11:23 AM
Contacts	Primary Contact	Update	Profile Change Request	Lindgren, Kristjon 340B Program Supervisor HonorHealth 6028706060-331353	Lindgren, Kristjon 340B Program Manager HonorHealth 6028706060-331353	4/5/2019 2:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008047201	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		092474100	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003176592A	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		860181654006	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		201035820A	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770690695	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		128579	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007457650007	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		12148B	12/17/2018 11:42 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	12/17/2018 11:42 AM
Addresses	Main Address	Update	Recertification	519 ROSE LANE Wickenburg, AZ 85390	519 Rose Ln Wickenburg, AZ 85390	8/22/2018 7:57 AM
Details	Last Recertification Date	Update	Recertification		8/22/2018 7:57:54 AM	8/22/2018 7:57 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Pope, Alice Chief Financial Officer HonorHealth 4808825544	4/11/2018 2:46 PM
Details	340B ID	Update	New Registration		DSH030014U	4/11/2018 2:46 PM
Details	Entity Subname	Update	New Registration	Virginia G Piper Cancer Care Network-Wickenburg	Virginia G Piper Cancer Care Network-Wickenburg - Virginia G Piper Cancer Care Network-Wickenburg	4/11/2018 2:46 PM
Dates	Participating Approval Date	Update	New Registration		4/11/2018 2:46:42 PM	4/11/2018 2:46 PM
Details	State	Update	New Registration	Pending	Approved	4/11/2018 2:46 PM
Dates	Signed By Date	Update	New Registration		4/9/2018 2:38:40 PM	4/11/2018 2:46 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/11/2018 2:46 PM
Addresses	Main Address	Insert	New Registration		519 ROSE LANE Wickenburg, AZ 85390	4/3/2018 3:50 PM
Addresses	Billing Address	Insert	New Registration		JOHN C LINCOLN MEDICAL CENTER 250 E Dunlap Ave Phoenix, AZ 85020	4/3/2018 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2018 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		022241	4/3/2018 3:50 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	4/3/2018 3:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770690695	4/3/2018 3:50 PM
Contacts	Primary Contact	Insert	New Registration		Lindgren, Kristjon 340B Program Supervisor HonorHealth 6028706060-331353	4/3/2018 3:50 PM
Contacts	Authorizing Official	Insert	New Registration		Pope, Alice Chief Financial Officer HonorHealth 4808825544	4/3/2018 3:50 PM
Details	Last Recertification Date	Insert	New Registration			4/3/2018 3:50 PM
Details	Grant Number	Insert	New Registration			4/3/2018 3:50 PM
Details	340B ID	Insert	New Registration			4/3/2018 3:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2018 3:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2018 3:50 PM
Details	Medicare Provider Number	Insert	New Registration		030014	4/3/2018 3:50 PM
Details	Entity Name	Insert	New Registration		JOHN C LINCOLN MEDICAL CENTER	4/3/2018 3:50 PM
Details	Program Code	Insert	New Registration		DSH	4/3/2018 3:50 PM
Details	Entity Subname	Insert	New Registration		Virginia G Piper Cancer Care Network-Wickenburg	4/3/2018 3:50 PM
Dates	Participating Approval Date	Insert	New Registration			4/3/2018 3:50 PM
Details	State	Insert	New Registration		Pending	4/3/2018 3:50 PM
Dates	Registration Date	Insert	New Registration		4/3/2018 3:50:45 PM	4/3/2018 3:50 PM
Dates	Signed By Date	Insert	New Registration			4/3/2018 3:50 PM
Dates	Start Date	Insert	New Registration			4/3/2018 3:50 PM
Terminations	Termination Comments	Insert	New Registration			4/3/2018 3:50 PM
Terminations	Termination Date	Insert	New Registration			4/3/2018 3:50 PM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2018 3:50 PM
Terminations	Termination Reason	Insert	New Registration			4/3/2018 3:50 PM