Covered Entity Details

DSH330285DT STRONG MEMORIAL HOSPITAL (Active) - information as of 4/23/2025 10:51:26 PM

Main Details

Name

STRONG MEMORIAL HOSPITAL

Subdivision Name

STRONG MEMORIAL HOSPITAL - SW SLEEP DISORDERS [3rd Floor]

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330285DT

Medicare Provider Number

330285

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2019

Participating Start Date

4/1/2019

Participating Approval Date

2/6/2019

Last Recertification Date

8/18/2024

Contacts

Authorizing Official

Strong Memorial Hospital & Highland Hospital
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033

Primary Contact

UR Medicine
Katy Lees, Director, 340B Policy and Business Strategy
(585) 703-5169 Ext: 5855964002

Addresses

Street Address

156 WEST AVENUE
URMC STRONG WEST
ROCHESTER, NY 14420-1229

Billing Address

Strong Memorial Hospital
601 Elmwood Avenue
Rochester, NY 14642

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

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

State	Medicaid Number	NPI Number
NY	00279034,03000406	1346285657,1821152588

Shipping Addresses

Shipping Address 1

Strong Memorial Hospital
601 Elmwood Avenue
Rochester, NY 14642

Shipping Address 2

Strong Memorial Hospital - Consolidated Services Center
155 Bellwood Drive
Rochester, NY 14606

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
DSH330285AA	Child	DSH	STRONG MEMORIAL HOSPITAL	Ortho Clinic Clinton Crossings	4901 Lac de Ville Blvd	Rochester	NY	Active
DSH330285AB	Child	DSH	STRONG MEMORIAL HOSPITAL	Women's Health Practice	125 Lattimore Rd	Rochester	NY	Active
DSH330285AC	Child	DSH	STRONG MEMORIAL HOSPITAL	PAIN TREATMENT CENTER	180 Sawgrass Drive	Rochester	NY	Active
DSH330285AD	Child	DSH	STRONG MEMORIAL HOSPITAL	Wound Care Center	160 Sawgrass Drive	Rochester	NY	Terminated
DSH330285AE	Child	DSH	STRONG MEMORIAL HOSPITAL	Outpatient Oncology Clinic	125 Red Creek Drive	Rochester	NY	Active
DSH330285AF	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Eastside Orthopedics and Rehab Clinic	2064 Fairport Nine Mile Point Road	Penfield	NY	Active
DSH330285AG	Child	DSH	STRONG MEMORIAL HOSPITAL	CLINTON CROSSINGS-INTERNAL MEDICINE-Pulsifer Internal Medicine	2400 South Clinton Avenue	ROCHESTER	NY	Active
DSH330285AH	Child	DSH	STRONG MEMORIAL HOSPITAL	OLSAN MEDICAL GROUP-Family Medicine	2400 S CLINTON AVENUE	ROCHESTER	NY	Active
DSH330285AJ	Child	DSH	STRONG MEMORIAL HOSPITAL	CLINTON MEDICAL ASSOCIATES-Internal Medicine	2400 S CLINTON AVENUE	ROCHESTER	NY	Active
DSH330285AK	Child	DSH	STRONG MEMORIAL HOSPITAL	CLINTON CROSSINGS INTERNAL MEDICINE	2400 S CLINTON AVENUE	ROCHESTER	NY	Active
DSH330285AL	Child	DSH	STRONG MEMORIAL HOSPITAL	URMC STRONG WEST	156 WEST AVE	BROCKPORT	NY	Active
DSH330285AM	Child	DSH	STRONG MEMORIAL HOSPITAL	Outpatient Oncology Clinic - Greece	155 Bellwood Drive	Rochester	NY	Active
DSH330285AN	Child	DSH	STRONG MEMORIAL HOSPITAL	Outpatient Oncology Clinic - Geneva	511 West Washington Street	GENEVA	NY	Active
DSH330285AP	Child	DSH	STRONG MEMORIAL HOSPITAL	Outpatient Oncology Clinic - Canandaigua	395 West Street	CANANDAIGUA	NY	Active
DSH330285AQ	Child	DSH	STRONG MEMORIAL HOSPITAL	URMC STRONG -URGENT CARE	42 NICHOLS ST	SPENCERPORT	NY	Active
DSH330285AR	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG WEST INTERNAL MEDICINE	156 WEST AVENUE	BROCKPORT	NY	Active
DSH330285AS	Child	DSH	STRONG MEMORIAL HOSPITAL	PULSIFER MEDICAL ASSOCIATES-Family Medicine	2400 S CLINTON AVENUE	ROCHESTER	NY	Terminated
DSH330285AT	Child	DSH	STRONG MEMORIAL HOSPITAL	CANALSIDE FAMILY MEDICINE	10 SOUTH POINTE LANDING	ROCHESTER	NY	Active
DSH330285AU	Child	DSH	STRONG MEMORIAL HOSPITAL	LEROY MEDICAL ASSOCIATES-Family Medicine	127 West Main Street	LEROY	NY	Active
DSH330285AV	Child	DSH	STRONG MEMORIAL HOSPITAL	CLINTON MEDICAL ASSOCIATES-Family Medicine	2400 S CLINTON AVENUE	ROCHESTER	NY	Terminated
DSH330285AW	Child	DSH	STRONG MEMORIAL HOSPITAL	Outpatient Oncology Clinic - Brockport	156 WEST AVENUE	Brockport	NY	Active
DSH330285AX	Child	DSH	STRONG MEMORIAL HOSPITAL	North Ponds Family Medicine	55 BARRETT DR	WEBSTER	NY	Active
DSH330285AY	Child	DSH	STRONG MEMORIAL HOSPITAL	BATAVIA ONCOLOGY CLINIC	7995 Call Parkway	BATAVIA	NY	Active
DSH330285AZ	Child	DSH	STRONG MEMORIAL HOSPITAL	Medical Associates of Henrietta	300 RED CREEK DRIVE	HENRIETTA	NY	Active
DSH330285BA	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG PSYCHIATRY CENTER O/P	315 SCIENCE PARKWAY	ROCHESTER	NY	Active
DSH330285BB	Child	DSH	STRONG MEMORIAL HOSPITAL	URMC GI & Hepatology at Sawgrass / Suite 230	180 Sawgrass Drive	Rochester	NY	Active
DSH330285BC	Child	DSH	STRONG MEMORIAL HOSPITAL	AIR Clinic at Lattimore	125 Lattimore Rd	Rochester	NY	Active
DSH330285BD	Child	DSH	STRONG MEMORIAL HOSPITAL	COMPLEX CARE CENTER	905 CULVER RD	ROCHESTER	NY	Active
DSH330285BE	Child	DSH	STRONG MEMORIAL HOSPITAL	EASTSIDE INTERNAL MEDICINE	800 AYRAULT RD	FAIRPORT	NY	Active
DSH330285BF	Child	DSH	STRONG MEMORIAL HOSPITAL	GATES MEDICAL ASSOCIATES	2135 BUFFALO RD	ROCHESTER	NY	Active
DSH330285BG	Child	DSH	STRONG MEMORIAL HOSPITAL	MANHATTAN SQUARE FAMILY MEDICINE	454 E BROAD ST	ROCHESTER	NY	Active
DSH330285BH	Child	DSH	STRONG MEMORIAL HOSPITAL	MEDICAL ASSOCIATES OF PENFIELD	1835 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285BJ	Child	DSH	STRONG MEMORIAL HOSPITAL	Ann and Carl Myers Cancer Center	111 CLARA BARTON ST	DANSVILLE	NY	Active
DSH330285BK	Child	DSH	STRONG MEMORIAL HOSPITAL	PANORAMA INTERNAL MEDICINE	2212 PENFIELD RD	PENFIELD	NY	Active
DSH330285BL	Child	DSH	STRONG MEMORIAL HOSPITAL	PEDIATRIC BEHAVIORAL HEALTH	200 EAST RIVER RD	ROCHESTER	NY	Active
DSH330285BM	Child	DSH	STRONG MEMORIAL HOSPITAL	PEDIATRIC NEUROLOGY	200 EAST RIVER RD	ROCHESTER	NY	Active
DSH330285BN	Child	DSH	STRONG MEMORIAL HOSPITAL	SOUTHVIEW INTERNAL MEDICINE	995 SENATOR KEATING BLVD	ROCHESTER	NY	Active
DSH330285BP	Child	DSH	STRONG MEMORIAL HOSPITAL	ROCHESTER INTERNAL MEDICINE ASSOCIA	2300 West Jefferson Road	Pittsford	NY	Active
DSH330285BQ	Child	DSH	STRONG MEMORIAL HOSPITAL	TWELVE CORNERS INTERNAL MEDICINE	400 White Spruce Blvd	ROCHESTER	NY	Terminated
DSH330285BR	Child	DSH	STRONG MEMORIAL HOSPITAL	CARDIOLOGY/RCPG	140 CANAL VIEW BLVD	ROCHESTER	NY	Active
DSH330285BS	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG HEALTH CARDIOLOGY-EAST RIDGE	999 E RIDGE RD	ROCHESTER	NY	Terminated
DSH330285BT	Child	DSH	STRONG MEMORIAL HOSPITAL	Interventional Radiology	200 East River Rd	Rochester	NY	Active
DSH330285BU	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - Cardiology at Strong West (Third Floor)	156 WEST AVENUE	ROCHESTER	NY	Active
DSH330285BV	Child	DSH	STRONG MEMORIAL HOSPITAL	URMC Vascular Surgery - Vascular Surgery	140 Canal View Blvd	Rochester	NY	Active
DSH330285BW	Child	DSH	STRONG MEMORIAL HOSPITAL	FREDERICK DOUGLAS HIGH SCHOOL - Frederick Douglas School Based Clinic	940 FERNWOOD PARK	ROCHESTER	NY	Terminated
DSH330285BX	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - Strong West Multi-Specialty Suite (GI) Suite 107	156 WEST AVENUE	ROCHESTER	NY	Active
DSH330285BY	Child	DSH	STRONG MEMORIAL HOSPITAL	EAST HIGH SCHOOL - East High School Based Clinic	1801 EAST MAIN STREET	ROCHESTER	NY	Active
DSH330285BZ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - Bushnell's Basin Primary Care	167 SULLYS TRL	PITTSFORD	NY	Active
DSH330285CA	Child	DSH	STRONG MEMORIAL HOSPITAL	SLEEP DISORDER/PFT SERVICES - SCLN SLEEP DISORDER	2337 S CLINTON AVENUE	ROCHESTER	NY	Active
DSH330285CB	Child	DSH	STRONG MEMORIAL HOSPITAL	WESTSIDE SPORTS MEDICINE - GREECE ORTHO SPORTS PT	10 SOUTH POINTE LANDING	GREECE	NY	Active
DSH330285CC	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Memorial Hospital - SMH BH CHILD PARTIAL	1860 South Avenue	ROCHESTER	NY	Active
DSH330285CD	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - LATTIMORE AIR	125 LATTIMORE RD	ROCHESTER	NY	Active
DSH330285CE	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Memorial Hospital - SMH BH MARRIAGE/FAMILY	300 CRITTENDEN BLVD	ROCHESTER	NY	Active
DSH330285CF	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEM EC - CC C MEMORY CARE PRGRM	919 WESTFALL RD - BLDG C	ROCHESTER	NY	Active
DSH330285CG	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER, STRONG MEM - Dermatology	40 Celebration Drive	ROCHESTER	NY	Active
DSH330285CH	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEM EC - CC C HEADACHE CENTER	919 WESTFALL RD - BLDG C	ROCHESTER	NY	Active
DSH330285CJ	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEM EC - CC C NEURO ATAXIA	4901 Lac de Ville Blvd	Rochester	NY	Active
DSH330285CK	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEM EC - CC C NEURO EPILEPSY	4901 Lac de Ville Blvd	Rochester	NY	Active
DSH330285CL	Child	DSH	STRONG MEMORIAL HOSPITAL	MUSCULOSKELETAL BLDG - CC D PHYS MED/REHAB	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285CM	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG TIES - STIES BH PROJECT ACT	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285CN	Child	DSH	STRONG MEMORIAL HOSPITAL	BATAVIA ONCOLOGY CLINIC - BATAVIA RAD ONC	262 Bank Street	BATAVIA	NY	Active
DSH330285CP	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Memorial Hospital - Ophthalmology	210 Crittenden Blvd	Rochester	NY	Active
DSH330285CQ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - LATTIMORE OBGYN BH	125 LATTIMORE RD	ROCHESTER	NY	Active
DSH330285CR	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Memorial Hospital - REDCK AIR INFUSION	400 RED CREEK DRIVE SUITE 240	ROCHESTER	NY	Active
DSH330285CS	Child	DSH	STRONG MEMORIAL HOSPITAL	MUSCULOSKELETAL BLDG - CC D STRONG OT - REHAB	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285CT	Child	DSH	STRONG MEMORIAL HOSPITAL	MUSCULOSKELETAL BLDG - CC D ORTHO SPORTS MED	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285CU	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG WEST INTERNAL MEDICINE - STRONG WEST SPNCPRT	42 NICHOLS ST	SPENCERPORT	NY	Active
DSH330285CV	Child	DSH	STRONG MEMORIAL HOSPITAL	PLUTA CANCER CENTER OF STRONG MEMOR - REDCK CANCER CTR OT	125 RED CREEK DRIVE	ROCHESTER	NY	Active
DSH330285CW	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG TIES - BBC BH CHEMICAL DEPEND	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285CX	Child	DSH	STRONG MEMORIAL HOSPITAL	IMAGING SCIENCE BUILDING - EAST RIVER IMAGING	200 EAST RIVER ROAD	ROCHESTER	NY	Active
DSH330285CY	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG TIES - STIES HOME CARE MGMNT	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285CZ	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH - SCLN STROKE	2400 S Clinton Ave	ROCHESTER	NY	Active
DSH330285D	Child	DSH	STRONG MEMORIAL HOSPITAL	Behavioral Health	300 CRITTENDEN BLVD	ROCHESTER	NY	Active
DSH330285DA	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - STRONG WEST OCC MED	156 WEST AVENUE	ROCHESTER	NY	Terminated
DSH330285DB	Child	DSH	STRONG MEMORIAL HOSPITAL	WESTSIDE SPORTS MEDICINE - GREECE ORTH HAND REHAB	10 SOUTH POINTE LANDING	GREECE	NY	Active
DSH330285DC	Child	DSH	STRONG MEMORIAL HOSPITAL	MUSCULOSKELETAL BLDG - CC D ORTHO HAND REHAB	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285DD	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - SW ORTHO SPORTS PT	156 WEST AVENUE	ROCHESTER	NY	Active
DSH330285DE	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - STRONG WEST IMAGING	156 WEST AVENUE	ROCHESTER	NY	Active
DSH330285DF	Child	DSH	STRONG MEMORIAL HOSPITAL	MUSCULOSKELETAL BLDG - CC D ORTHO SPORTS PT	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285DG	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG TIES - STIES ASSERTIVE COMM	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285DH	Child	DSH	STRONG MEMORIAL HOSPITAL	CHSNT BH-OMH DEAF WELLNESS (SMH)	150 N Chestnut Street	ROCHESTER	NY	Active
DSH330285DJ	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - SW WOUND HEALING	156 WEST AVENUE	ROCHESTER	NY	Terminated
DSH330285DK	Child	DSH	STRONG MEMORIAL HOSPITAL	PLUTA CANCER CENTER OF STRONG MEMOR - REDCK PLUTA RAD ONC	125 RED CREEK DRIVE	ROCHESTER	NY	Active
DSH330285DL	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG EASTSIDE ORTHOPEDICS & REHAB - PNFLD ORTHO HAND REHAB	2064 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285DM	Child	DSH	STRONG MEMORIAL HOSPITAL	Strong Memorial Hospital - SMH BH ADULT GENERAL	300 CRITTENDEN BLVD	ROCHESTER	NY	Active
DSH330285DN	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BRKPT DERM	80 WEST AVE	BROCKPORT	NY	Active
DSH330285DP	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG HEALTH CARDIOLOGY-CANAL VIEW - CANAL VIEW VASC VEIN	140 CANAL VIEW BLVD	ROCHESTER	NY	Active
DSH330285DQ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - GREECE URGENT CARE	2047 W RIDGE RD	ROCHESTER	NY	Active
DSH330285DR	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH - SCLN PEDS SLEEP CTR	2180 CLINTON S AVE	ROCHESTER	NY	Active
DSH330285DS	Child	DSH	STRONG MEMORIAL HOSPITAL	Behavioral Health - SMH BH CHILD PARTIAL	300 Crittenden Blvd	Rochester	NY	Terminated
DSH330285DT	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - SW SLEEP DISORDERS [3rd Floor]	156 WEST AVENUE	ROCHESTER	NY	Active
DSH330285DU	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG HEALTH CARDIOLOGY-CANAL VIEW - CANAL VIEW RCPG DEVICE	140 CANAL VIEW BLVD	ROCHESTER	NY	Active
DSH330285DV	Child	DSH	STRONG MEMORIAL HOSPITAL	IMAGING SCIENCE BUILDING - EAST RIVER PEDS EPIL	200 EAST RIVER ROAD	ROCHESTER	NY	Active
DSH330285DW	Child	DSH	STRONG MEMORIAL HOSPITAL	CC E PEDS GI - Pediatric GI	995 Senator Keating Blvd	Rochester	NY	Active
DSH330285DX	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG HEALTH CARDIOLOGY-EAST RIDGE - EAST RIDGE RCPG	999E RIDGE RD	ROCHESTER	NY	Active
DSH330285DY	Child	DSH	STRONG MEMORIAL HOSPITAL	PLUTA CANCER CENTER OF STRONG MEMOR - REDCK COMP BREAST CARE	125 RED CREEK DRIVE	ROCHESTER	NY	Active
DSH330285DZ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - REDCK MOHS DERMATOLOGY	400 RED CREEK DR	ROCHESTER	NY	Active
DSH330285E	Child	DSH	STRONG MEMORIAL HOSPITAL	OUTPATIENT IMAGING SCIENCE DEPARTMENT	601 ELMWOOD AVENUE	ROCHESTER	NY	Active
DSH330285EA	Child	DSH	STRONG MEMORIAL HOSPITAL	Behavioral Health - SMH NEURO SEC @ BH	300 Crittenden Blvd	Rochester	NY	Active
DSH330285EB	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH INFUSION CENTER AT HIGHLAND HOS - Outpatient Oncology at HH	1000 SOUTH AVE	ROCHESTER	NY	Active
DSH330285EC	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - REDCK DERM	400 RED CREEK DR	ROCHESTER	NY	Active
DSH330285ED	Child	DSH	STRONG MEMORIAL HOSPITAL	DERM MOHS SURGERY COLLEGE TOWN SMH - Dermatology	40 Celebration Drive	Rochester	NY	Active
DSH330285EE	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH BH ECT - Behavioral Health	300 Crittenden Blvd	Rochester	NY	Active
DSH330285EF	Child	DSH	STRONG MEMORIAL HOSPITAL	CLINTON CROSSING NUCLEAR CARDIOLOGY - Cardiology and Rapid Discharge	2400 CLINTON AVE S	ROCHESTER	NY	Active
DSH330285EG	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEM EC - CC C Neuro Infusion	919 WESTFALL RD - BLDG C	ROCHESTER	NY	Active
DSH330285EH	Child	DSH	STRONG MEMORIAL HOSPITAL	SAWG Urology - Urology	158 Sawgrass Drive	Rochester	NY	Active
DSH330285EJ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - PNFLD RCPG	1835 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285EK	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG WOUND HEALING CENTER - SAWG OSTOMY SERVICES	160 SAWGRASS DR	ROCHESTER	NY	Active
DSH330285EL	Child	DSH	STRONG MEMORIAL HOSPITAL	PERINTON URGENT CARE - PERINTON URGENT CARE	1669 PITTSFORD VICTOR RD	VICTOR	NY	Active
DSH330285EM	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - PERINTON PEDIATRICS	1669 PITTSFORD VICTOR RD 100	VICTOR	NY	Active
DSH330285EN	Child	DSH	STRONG MEMORIAL HOSPITAL	PITTSFORD URGENT CARE - PITTSFORD URGENT CARE	3400 MONROE AVE	ROCHESTER	NY	Active
DSH330285EP	Child	DSH	STRONG MEMORIAL HOSPITAL	Behavioral Health - STH AVE BH CHILD/ADOL	1860 South Avenue	Rochester	NY	Active
DSH330285EQ	Child	DSH	STRONG MEMORIAL HOSPITAL	THOMPSON POB - TMPSN POB MULTI-SPECIALTY SUITE	395 WEST ST	CANANDAIGUA	NY	Active
DSH330285ER	Child	DSH	STRONG MEMORIAL HOSPITAL	NORTH GREECE PRIMARY CARE - NGREECE MED PEDS	60 GREECE CENTER DR, STE 4	ROCHESTER	NY	Active
DSH330285ES	Child	DSH	STRONG MEMORIAL HOSPITAL	PARTNERS IN INTERNAL MEDICINE - PANORAMA PARTNERS IM	959 PANORAMA TRL S	ROCHESTER	NY	Active
DSH330285ET	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG TIES - STIES YOUNG ADULT	2613 WEST HENRIETTA ROAD	ROCHESTER	NY	Active
DSH330285EU	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH BH ADULT GENERAL - CHSNT BH ADULT AND LAZOS FUERTES	150 N CHESTNUT ST	ROCHESTER	NY	Active
DSH330285EV	Child	DSH	STRONG MEMORIAL HOSPITAL	EAST RIVER PEDS RHEUM - EAST RIVER PEDS RHEUM AND ERR PEDS RHEUM BHDOH	200 E RIVER RD	ROCHESTER	NY	Active
DSH330285EW	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - NGREECE NEUROSURGERY	60 GREECE CENTER DR	ROCHESTER	NY	Active
DSH330285EX	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH GREECE NEUROSURGERY - GREECE NEUROSURGERY	10 S POINTE LNDG	ROCHESTER	NY	Active
DSH330285EY	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BH MOBILE CRISIS	2617 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285EZ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - SAWG CTR PERIOP MED	158 SAWGRASS DR	ROCHESTER	NY	Active
DSH330285F	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL AT STRONG TIES	2613 WEST HENRIETTA ROAD	ROCHESTER	NY	Active
DSH330285FA	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - LATTIMORE BLD COAG AND INFS	125 LATTIMORE RD	ROCHESTER	NY	Active
DSH330285FB	Child	DSH	STRONG MEMORIAL HOSPITAL	BATAVIA PRIMARY CARE - BATVA CP PRIM CARE	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285FC	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP UROLOGY	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285FD	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP ALLERGY/IMM	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285FE	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP NEUROSURGERY	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285FF	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - REDCK OBG GENETICS	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285FG	Child	DSH	STRONG MEMORIAL HOSPITAL	URMC WOMENS HEALTH CENTER AT LATTIM - LATTIMORE GYN ONCOLOGY	125 LATTIMORE RD	ROCHESTER	NY	Active
DSH330285FH	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG EASTSIDE ORTHOPEDICS & REHAB - PNFLD UNIV IMG MRI AND US	2064 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285FJ	Child	DSH	STRONG MEMORIAL HOSPITAL	REDCK OBGYN SPA AND ULTRASOUND - REDCK OBGYN SPA AND ULTRASOUND	500 RED CREEK DRIVE	ROCHESTER	NY	Active
DSH330285FK	Child	DSH	STRONG MEMORIAL HOSPITAL	SMH - SCLN PITUITARY	2180 CLINTON S AVE	ROCHESTER	NY	Active
DSH330285FL	Child	DSH	STRONG MEMORIAL HOSPITAL	REDCK PLUTA NEURO ONC - REDCK PLUTA NEURO ONC	125 RED CREEK DR	ROCHESTER	NY	Active
DSH330285FM	Child	DSH	STRONG MEMORIAL HOSPITAL	BIVONIA CHILD ADVOCACY CENTER - MT HOPE ADOLESCENT MED	1 MOUNT HOPE AVE	ROCHESTER	NY	Active
DSH330285FN	Child	DSH	STRONG MEMORIAL HOSPITAL	OUTPATIENT ONCOLOGY CLINIC-GENEVA - GENEVA GYN ONCOLOGY	511W WASHINGTON ST	GENEVA	NY	Active
DSH330285FP	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG RECOVERY - BHC BH CHEMICAL DEPEND	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285FQ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BHC BH ADULT PARTIAL AND ADO/YNG ADLT CD	2613 W HENRIETTA RD	ROCHESTER	NY	Active
DSH330285FR	Child	DSH	STRONG MEMORIAL HOSPITAL	CC H PHYS MED REHAB - CC H PHYS MED/REHAB	2400 S CLINTON AVE	ROCHESTER	NY	Active
DSH330285FS	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC F PCA RESPRTRY CLNC	2400 CLINTON S AVE F	ROCHESTER	NY	Terminated
DSH330285FT	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - Marketplace Imaging	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285FU	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP SURGICAL CENTER	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285FV	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - WEBSTER WILMOT CANCER INSTITUTE	875 HARD RD	WEBSTER	NY	Active
DSH330285FW	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - PNFLD SPORTS BHDOH	2064 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285FX	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - WEBSTER URGENT CARE	2070 EMPIRE BLVD	WEBSTER	NY	Active
DSH330285FY	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC C NEUROPALLIATIVE	919 WESTFALL RD	ROCHESTER	NY	Active
DSH330285FZ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - WBSTR HR OPHTHALMOLOGY	875 HARD RD	WEBSTER	NY	Active
DSH330285H	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL INFUSION CENTER	1000 SOUTH AVENUE	ROCHESTER	NY	Active
DSH330285HA	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP ORTHO INJ/INF STE	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285HB	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CNDGA CMNS UROLOGY	699 S MAIN ST	CANANDAIGUA	NY	Active
DSH330285HC	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP OTOLARYNG	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285HD	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC D PEDS PHYS THERAPY	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285HE	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP ORTHO PROC AND PERIOP	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285HF	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC D PEDS OCC THERAPY	4901 LAC DE VILLE BLVD	ROCHESTER	NY	Active
DSH330285HG	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - SW ALLERGY/IMMUNOLOGY	156 WEST AVE	BROCKPORT	NY	Active
DSH330285HH	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC C NEUROMUSCULAR EMG	919 WESTFALL RD	ROCHESTER	NY	Active
DSH330285HJ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - NGREECE OTOLARYNGOLOGY	60 GREECE CENTER DR	ROCHESTER	NY	Active
DSH330285HK	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP NEUROLOGY	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285HL	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - STRONG WEST GEN SURG	156 WEST AVE	ROCHESTER	NY	Active
DSH330285HM	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC H OT - REHAB	2400 S CLINTON AVE	ROCHESTER	NY	Active
DSH330285HN	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC C NEUROIMMUNOLOGY-1	919 WESTFALL RD	ROCHESTER	NY	Active
DSH330285HP	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP ORTHO MOTION LAB	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285HQ	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - PNFLD PMR PT-REHAB	2064 FAIRPORT NINE MILE POINT RD	PENFIELD	NY	Active
DSH330285HR	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC F PHYS MED/REHAB	2400 CLINTON S AVE F	ROCHESTER	NY	Active
DSH330285HS	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP ORTHO HAND REHAB	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285HT	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - BATVA CP IMG	7995 CALL PKWY	BATAVIA	NY	Active
DSH330285HU	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - MP ORTHO SPORTS THPY	10 MIRACLE MILE DR	ROCHESTER	NY	Active
DSH330285HV	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - SW GEN NEPHROLOGY AND UROLOGY	156 WEST AVE	ROCHESTER	NY	Active
DSH330285HW	Child	DSH	STRONG MEMORIAL HOSPITAL	UNIVERSITY OF ROCHESTER - CC C BH NEUROLOGY	919 WESTFALL RD	ROCHESTER	NY	Active
DSH330285I	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL CANCER CENTER	601 Elmwood Avenue	ROCHESTER	NY	Active
DSH330285J	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL AMBULATORY CARE SATELLITE	601 ELMWOOD AVE	ROCHESTER	NY	Terminated
DSH330285L	Child	DSH	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL AMBULATORY SURGICAL CENTER	180 Sawgrass Drive	ROCHESTER	NY	Active
DSH330285M	Child	DSH	STRONG MEMORIAL HOSPITAL	Cardiac Rehab Clinic	140 Canal View Blvd	Rochester	NY	Active
DSH330285N	Child	DSH	STRONG MEMORIAL HOSPITAL	Clinton Crossing Nuclear Cardiology	2400 South Clinton Avenue	Rochester	NY	Active
DSH330285P	Child	DSH	STRONG MEMORIAL HOSPITAL	OCC MEDICINE	400 Red Creek Drive	Rochester	NY	Terminated
DSH330285Q	Child	DSH	STRONG MEMORIAL HOSPITAL	Audiology Clinton Wood	2365 South Clinton Avenue	Rochester	NY	Terminated
DSH330285R	Child	DSH	STRONG MEMORIAL HOSPITAL	Mary M Parks Center, Pulmonary Center	400 Red Creek Drive	Rochester	NY	Active
DSH330285T	Child	DSH	STRONG MEMORIAL HOSPITAL	Clinton Perinatal Clinic	500 Red Creek Drive	Rochester	NY	Terminated
DSH330285U	Child	DSH	STRONG MEMORIAL HOSPITAL	Neuromedicine Pain Management	2180 South Clinton Avenue	Rochester	NY	Active
DSH330285V	Child	DSH	STRONG MEMORIAL HOSPITAL	Allergy, Immunology, and Rheumatology	400 Red Creek Drive	Rochester	NY	Active
DSH330285W	Child	DSH	STRONG MEMORIAL HOSPITAL	Neurology	919 Westfall Rd	Rochester	NY	Active
DSH330285Z	Child	DSH	STRONG MEMORIAL HOSPITAL	OPD MED Neurology	2400 South Clinton Avenue	Rochester	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/20/2023 9:43:22 AM	8/18/2024 10:38:51 AM	8/18/2024 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/28/2022 9:22:53 AM	8/20/2023 9:43:22 AM	8/20/2023 9:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/28/2022 9:22 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		03000406	8/28/2022 9:22 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	8/28/2022 9:22 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 1:20:55 PM	8/28/2022 9:22:53 AM	8/28/2022 9:22 AM
Details	Last Recertification Date	Update	Recertification	9/13/2020 4:26:52 PM	9/8/2021 1:20:55 PM	9/8/2021 1:20 PM
Contacts	Primary Contact	Update	Change Request	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169-5855964002	12/10/2020 8:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1346285657	9/13/2020 4:26 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/13/2020 4:26 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1821152588	9/13/2020 4:26 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/13/2020 4:26 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1346285657 ( )		9/13/2020 4:26 PM
Details	Last Recertification Date	Update	Recertification	9/8/2019 7:42:36 AM	9/13/2020 4:26:52 PM	9/13/2020 4:26 PM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857855154	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857035169	9/3/2020 12:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy Associate Director of Pharmacy, 340B Policy and Business Strategy UR Medicine 5857855154	Lees, Katy Director, 340B Policy and Business Strategy UR Medicine 5857855154	8/21/2020 9:29 AM
Contacts	Primary Contact	Update	Profile Change Request	Lees, Katy 340B Business Manager UR Medicine 5857855154	Lees, Katy Associate Director of Pharmacy, 340B Policy and Business Strategy UR Medicine 5857855154	10/28/2019 11:14 AM
Contacts	Authorizing Official	Update	Profile Change Request	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital & Highland Hospital 5852753033	9/11/2019 10:34 AM
Contacts	Signed By	Update	Profile Change Request	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital & Highland Hospital 5852753033	9/11/2019 10:34 AM
Addresses	Shipping Address	Insert	Recertification		Strong Memorial Hospital - Consolidated Services Center 155 Bellwood Drive Rochester, NY 14606	9/8/2019 7:42 AM
Details	Last Recertification Date	Update	Recertification		9/8/2019 7:42:36 AM	9/8/2019 7:42 AM
Contacts	Authorizing Official	Update	Profile Change Request	Fuller-Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	9/6/2019 10:41 AM
Contacts	Signed By	Update	Profile Change Request	Fuller-Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	Fuller Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	9/6/2019 10:41 AM
Contacts	Authorizing Official	Update	Profile Change Request	Fuller-Spencer, Carrie Senior Director of Financial Services Strong Memorial Hospital 5852753033	Fuller-Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	9/6/2019 10:41 AM
Contacts	Signed By	Update	Profile Change Request	Fuller-Spencer, Carrie Senior Director of Financial Services Strong Memorial Hospital 5852753033	Fuller-Spencer, Carrie Chief Financial Officer Strong Memorial Hospital 5852753033	9/6/2019 10:41 AM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Fuller-Spencer, Carrie Senior Director of Financial Services Strong Memorial Hospital 5852753033	2/6/2019 1:02 PM
Details	340B ID	Update	New Registration		DSH330285DT	2/6/2019 1:02 PM
Details	Entity Subname	Update	New Registration	STRONG MEMORIAL HOSPITAL	STRONG MEMORIAL HOSPITAL - SW SLEEP DISORDERS [3rd Floor]	2/6/2019 1:02 PM
Dates	Participating Approval Date	Update	New Registration		2/6/2019 1:02:44 PM	2/6/2019 1:02 PM
Details	State	Update	New Registration	Pending	Approved	2/6/2019 1:02 PM
Dates	Signed By Date	Update	New Registration		1/10/2019 8:55:14 AM	2/6/2019 1:02 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	2/6/2019 1:02 PM
Addresses	Main Address	Insert	New Registration		156 WEST AVENUE URMC STRONG WEST ROCHESTER, NY 14420-1229	1/9/2019 3:53 PM
Addresses	Billing Address	Insert	New Registration		Strong Memorial Hospital 601 Elmwood Avenue Rochester, NY 14642	1/9/2019 3:53 PM
Addresses	Shipping Address	Insert	New Registration		Strong Memorial Hospital 601 Elmwood Avenue Rochester, NY 14642	1/9/2019 3:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2019 3:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00279034	1/9/2019 3:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/9/2019 3:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346285657	1/9/2019 3:53 PM
Contacts	Primary Contact	Insert	New Registration		Lees, Katy 340B Business Manager UR Medicine 5857855154	1/9/2019 3:53 PM
Contacts	Authorizing Official	Insert	New Registration		Fuller-Spencer, Carrie Senior Director of Financial Services Strong Memorial Hospital 5852753033	1/9/2019 3:53 PM
Details	Last Recertification Date	Insert	New Registration			1/9/2019 3:53 PM
Details	Grant Number	Insert	New Registration			1/9/2019 3:53 PM
Details	340B ID	Insert	New Registration			1/9/2019 3:53 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2019 3:53 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2019 3:53 PM
Details	Medicare Provider Number	Insert	New Registration		330285	1/9/2019 3:53 PM
Details	Entity Name	Insert	New Registration		STRONG MEMORIAL HOSPITAL	1/9/2019 3:53 PM
Details	Program Code	Insert	New Registration		DSH	1/9/2019 3:53 PM
Details	Entity Subname	Insert	New Registration		STRONG MEMORIAL HOSPITAL	1/9/2019 3:53 PM
Dates	Participating Approval Date	Insert	New Registration			1/9/2019 3:53 PM
Details	State	Insert	New Registration		Pending	1/9/2019 3:53 PM
Dates	Registration Date	Insert	New Registration		1/9/2019 3:53:49 PM	1/9/2019 3:53 PM
Dates	Signed By Date	Insert	New Registration			1/9/2019 3:53 PM
Dates	Start Date	Insert	New Registration			1/9/2019 3:53 PM
Terminations	Termination Comments	Insert	New Registration			1/9/2019 3:53 PM
Terminations	Termination Date	Insert	New Registration			1/9/2019 3:53 PM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2019 3:53 PM
Terminations	Termination Reason	Insert	New Registration			1/9/2019 3:53 PM