340B Drug Pricing Program Database


CHC12885-05 Houston Area Community Services, Inc. (Terminated) - information as of 4/25/2025 5:41:24 PM

Main Details
Houston Area Community Services, Inc.
Avenue 360 South Central
HRSA-Funded Health Center
BPS-H80-023384
CHC12885-05
H80CS12885


Additional Details
Terminated
1/11/2019
4/1/2019
1/22/2019
2/15/2023

7/1/2023
Business decision by the Covered Entity

Contacts

Houston Area Community Services
Charlene Antoinette Flash, CEO
(832) 384-1479 Ext: 494

Houston Area Community Services dba Avenue 360 Health and Wellness
Emmily Simmons, PIC
(713) 426-0027

Addresses

4405 Griggs
Houston, TX 77021-2815

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC12885-01ActiveBPS-H80-013540Houston Area Community Services, IncHACS: Spring-Cypress17010 SUGAR PINE DR HOUSTONTX
CHC12885-02ActiveBPS-H80-012486Houston Area Community Services, IncHACS: Bautista902 Frostwood Dr STE 142 HoustonTX
CHC12885-03ActiveSPB-H80-009621HOUSTON AREA COMMUNITY SERVICES, INCHACS: Main Campus2150 W 18th St HoustonTX
CHC12885-04ActiveBPS-H80-032563HOUSTON AREA COMMUNITY SERVICES, INCAvenue 360 Health & Wellness - Midtown2920 Fannin HoustonTX
CHC12885-05TerminatedBPS-H80-023384Houston Area Community Services, Inc.Avenue 360 South Central4405 Griggs HoustonTX
CHC12885-06ActiveBPS-H80-037905Houston Area Community Services, Inc. dba Avenue 360 Health & WellnessAvenue 360 Health and Wellness - Humble18842 S Memorial Dr HumbleTX
CHC12885-07ActiveBPS-H80-027186Houston Area Community Services, Inc.AVENUE 360 Southwest14095 S Main St HoustonTX
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC12885-03ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2022  
CHC12885-03ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2022  
CHC12885-03ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2022  
CHC12885-03ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/01/2022  
CHC12885-03ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2022  
CHC12885-03ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2022  
CHC12885-03ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2022  
CHC12885-03ACCREDO HEALTH GROUP, INC.  PHARMACY
2 BOULDEN CIRCLE SUITE 1 		NEW CASTLEDE1972007/01/2022  
CHC12885-01ASPCARES3009 FANNIN ST
HOUSTONTX77004-280501/01/2020  
CHC12885-03AVITA PHARMACY 1028340B PARTNERS PHARMACY-DALLAS LLC DBA AV 750 FORT WORTH AVE STE H100
DALLASTX75208-181110/01/2016 09/30/2022
CHC12885-03AVITA PHARMACY 1029340B PARTNERS PHARMACY LLC D/B/A AVITA P 303 N FRIO ST
SUITE 102 		SAN ANTONIOTX78207-303410/01/2016 09/30/2022
CHC12885-03AVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011910/01/2016 09/30/2022
CHC12885-03AVITA PHARMACY 1038AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM 3308 TULANE AVE STE 102
NEW ORLEANSLA70119-717010/01/2016 09/30/2022
CHC12885-03AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080810/01/2016 09/30/2022
CHC12885-03ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2022  
CHC12885-03EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2022  
CHC12885-03EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2022  
CHC12885-03EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2022  
CHC12885-01KROGER PHARMACY #6072300 N GESSNER
HOUSTONTX7708001/01/2020 04/01/2022
CHC12885-03KROGER PHARMACY #6072300 N GESSNER
HOUSTONTX7708007/01/2020 04/15/2022
CHC12885-03OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2022 08/01/2023
CHC12885-03OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2022 08/01/2023
CHC12885-03OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824907/01/2022 08/01/2023
CHC12885-03OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2022 08/01/2023
CHC12885-01WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2020 08/31/2023
CHC12885-01WAL-MART PHARMACY 10-140910750 WESTVIEW DR
HOUSTONTX7704301/01/2020 08/31/2023
CHC12885-01WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2020 08/31/2023
CHC12885-01WALGREEN CODBA: WALGREENS #15515 18400 KATY FREEWAY
SUITE 100 		HOUSTONTX7709401/01/2020 11/14/2022
CHC12885-01WALGREEN CODBA WALGREENS SPECIALTY PHARMACY #15514 16605 SOUTHWEST FWY MOB3 STE 100
SUGAR LANDTX7747901/01/2020  
CHC12885-01WALGREEN CODBA: WALGREENS #11752 915 GESSNER SUITE 200
HOUSTONTX7702401/01/2020 08/24/2020
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05094 14616 MEMORIAL DRIVE
HOUSTONTX7707901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06619 1215 W 43RD STREET
HOUSTONTX7701801/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04927 6675 W BELLFORT ST
HOUSTONTX7703501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07251 11038 WESTHEIMER ROAD
HOUSTONTX77042-320601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07722 11994 RICHMOND AVE
HOUSTONTX77082-682701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07491 6802 S FRY RD
KATYTX77494-829401/01/2020  
CHC12885-01WALGREEN CO.WALGREENS #16061 14021 STUEBNER AIRLINE RD
HOUSTONTX7706901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05313 1506 ELDRIDGE PARKWAY
HOUSTONTX7707701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07671 24424 TOMBALL PKWY
TOMBALLTX7737501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09946 14127 CYPRESS ROSEHILL ROAD
CYPRESSTX77429-270601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06907 6600 AIRLINE DRIVE
HOUSTONTX7707601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03870 4995 HWY 6 NORTH
HOUSTONTX7708401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05390 8300 WILCREST
HOUSTONTX7707201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04840 2240 NORTH PARK DRIVE
KINGWOODTX7733901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07071 13196 BELLAIRE BLVD
HOUSTONTX77072-510201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03157 3317 MONTROSE BLVD.
HOUSTONTX7700601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07725 14625 FM 529 ROAD
HOUSTONTX7709501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03449 12025 HUFFMEISTER
CYPRESSTX7742901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 10259 10660 EASTEX FREEWAY
HOUSTONTX77093-432401/01/2020  
CHC12885-01WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15320 4101 GREENBRIAR DR STE 235
HOUSTONTX7709801/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #15155 107 W. RANKIN RD.
HOUSTONTX7709001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #15968 15110 MASON RD
CYPRESSTX7743301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04161 8206 HIGHWAY 6 NORTH
HOUSTONTX7709501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 13786 200 WEST 20TH ST
HOUSTONTX7700801/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04513 1403 FM 1960 W
HOUSTONTX7709001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05871 1838 S KIRKWOOD RD
HOUSTONTX7707701/01/2020 11/06/2023
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03407 12550 WESTHEIMER RD
HOUSTONTX7707701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07381 17150 FM 529
HOUSTONTX77095-120601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #15681 9423 SPRING GREEN BLVD
KATYTX7749401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03160 6280 BARKER CYPRESS
HOUSTONTX7708401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05733 6302 FAIRMONT PKWY
PASADENATX7750501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06857 950 STUDEMONT STREET
HOUSTONTX77007-592301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07561 11803 BARKER CYPRESS RD
CYPRESSTX7743301/01/2020  
CHC12885-01WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15086 6560 FANNIN ST STE 260
HOUSTONTX7703001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03717 4841 MOUNT HOUSTON RD
HOUSTONTX7709301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03691 20500 FM 529 RD
CYPRESSTX7743301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09471 5501 WEST OREM DR
HOUSTONTX77085-125301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #13062 25620 KINGSLAND BLVD.
KATYTX7749401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #21318 12620 FM 1960 RD W STE C1
HOUSTONTX77065-536401/01/2020 03/18/2025
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04839 2010 S FRY ROAD
KATYTX7745001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04316 10800 S POST OAK ROAD
HOUSTONTX7703501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03661 6768 HIGHWAY 6 SOUTH
HOUSTONTX7708301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09002 6320 N ELDRIDGE PKWY
HOUSTONTX77041-350401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05835 5002 BELLAIRE BLVD
BELLAIRETX7740101/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05536 2808 GESSNER RD
HOUSTONTX7708001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 02844 5202 ALMEDA RD
HOUSTONTX7700401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03441 1710 FRY ROAD
HOUSTONTX7708401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07492 6402 FM 1960 ROAD W
HOUSTONTX77069-390201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07681 8505 FM 1960 W
HUMBLETX7733801/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06932 24917 FM 1314 RD
PORTERTX77365-498201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09808 2612 SMITH ST
HOUSTONTX7700601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06821 11675 W AIRPORT BLVD
MEADOWS PLACETX7747701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03198 7634 BELLAIRE BLVD
HOUSTONTX7703601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04696 411 S MASON RD
KATYTX7745001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 11465 3822 OLD SPANISH TRAIL
HOUSTONTX7702101/01/2020 01/23/2025
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04027 5200 WESTHEIMER ROAD
HOUSTONTX7705601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 10522 7777 SOUTHWEST FREEWAY STE 104
HOUSTONTX7707401/01/2020 08/24/2020
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03735 1919 W GRAY
HOUSTONTX7701901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03025 7440 FM 1960 E.
HUMBLETX7734601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03328 12850 MEMORIAL DRIVE
HOUSTONTX7702401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05423 1413 WIRT ROAD
HOUSTONTX7705501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06702 3403 MANGUM ROAD
HOUSTONTX77092-741501/01/2020  
CHC12885-01WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #10846 6400 FANNIN ST STE 102
HOUSTONTX7703001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06484 9600 WESTHEIMER RD
HOUSTONTX7706301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09601 3755 ATASCOCITA ROAD
HUMBLETX7739601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 05671 4445 KINGWOOD DRIVE
KINGWOODTX7733901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 09473 12300 JONES RD
HOUSTONTX77070-480201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03848 3300 CENTER ST
DEER PARKTX7753601/01/2020  
CHC12885-01WALGREEN CO.DBA WALGREENS #15542 20824 FM 1485 RD
NEW CANEYTX7735701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06668 9450 HAMMERLY BLVD
HOUSTONTX77080-540001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04745 5280 BUFFALO SPEEDWAY
HOUSTONTX7700501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04078 5161 FRANZ ROAD
KATYTX7749301/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06909 4007 BARKER CYPRESS ROAD
HOUSTONTX77084-680201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07101 16211 SPRING CYPRESS ROAD
CYPRESSTX77429-170701/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07530 1770 W T C JESTER BLVD
HOUSTONTX77008-320001/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 01583 9329 KATY FREEWAY
HOUSTONTX7702401/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 03820 8590 LONG POINT RD
HOUSTONTX7705501/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 16261 6486 W LITTLE YORK RD
HOUSTONTX7709101/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 04114 510 CHIMNEY ROCK ROAD
HOUSTONTX7705601/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS #21341 168 1ST ST W
HUMBLETX7733801/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07560 8207 BARKER CYPRESS ROAD
CYPRESSTX77433-121201/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 07019 3120 N FRY RD
KATYTX77449-623901/01/2020  
CHC12885-01WALGREEN CO.DBA: WALGREENS # 06401 8942 W SAM HOUSTON PKWY NORT
HOUSTONTX7704001/01/2020  
CHC12885-03Walgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626207/01/2022  
CHC12885-01WALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528401/01/2020  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated7/1/2023 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 3/17/2023 12:00:00 AM5/16/2023 4:40 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated5/16/2023 4:40 PM
TerminationsTermination DateUpdateTermination Request 7/1/2023 12:00:00 AM5/16/2023 4:40 PM
TerminationsTermination Effective DateUpdateTermination Request 3/31/2023 12:00:00 AM5/16/2023 4:40 PM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity5/16/2023 4:40 PM
DetailsLast Recertification DateUpdateRecertification2/1/2022 4:54:53 PM2/15/2023 11:26:52 AM2/15/2023 11:26 AM
DetailsLast Recertification DateUpdateRecertification2/20/2021 10:42:20 PM2/1/2022 4:54:53 PM2/1/2022 4:54 PM
DetailsLast Recertification DateUpdateRecertification2/18/2020 10:18:45 AM2/20/2021 10:42:20 PM2/20/2021 10:42 PM
DetailsLast Recertification DateUpdateRecertification 2/18/2020 10:18:45 AM2/18/2020 10:18 AM
ContactsAuthorizing OfficialUpdateAO Change RequestFuentes, Joe C. CEO Houston Area Community Services dba Avenue 360 Health and Wellness 7134260027Flash, Charlene Antoinette CEO Houston Area Community Services 8323841479-4942/13/2020 11:57 AM
DetailsStateUpdate ApprovedActive4/1/2019 12:05 AM
ContactsSigned ByInsertNew Registration Fuentes, Joe C. CEO Houston Area Community Services dba Avenue 360 Health and Wellness 71342600271/22/2019 2:21 PM
Details340B IDUpdateNew Registration CHC12885-051/22/2019 2:21 PM
DatesParticipating Approval DateUpdateNew Registration 1/22/2019 2:21:02 PM1/22/2019 2:21 PM
DetailsStateUpdateNew RegistrationPendingApproved1/22/2019 2:21 PM
DatesSigned By DateUpdateNew Registration 1/11/2019 1:31:39 PM1/22/2019 2:21 PM
DatesStart DateUpdateNew Registration 4/1/2019 12:00:00 AM1/22/2019 2:21 PM
AddressesMain AddressInsertNew Registration  4405 Griggs Houston, TX 77021-28151/11/2019 1:31 PM
ContactsAuthorizing OfficialInsertNew Registration Fuentes, Joe C. CEO Houston Area Community Services dba Avenue 360 Health and Wellness 71342600271/11/2019 1:31 PM
ContactsPrimary ContactInsertNew Registration Simmons, Emmily PIC Houston Area Community Services dba Avenue 360 Health and Wellness 71342600271/11/2019 1:31 PM
DetailsLast Recertification DateInsertNew Registration  1/11/2019 1:31 PM
DetailsGrant NumberInsertNew Registration H80CS128851/11/2019 1:31 PM
Details340B IDInsertNew Registration  1/11/2019 1:31 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/11/2019 1:31 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/11/2019 1:31 PM
DetailsMedicare Provider NumberInsertNew Registration  1/11/2019 1:31 PM
DetailsEntity NameInsertNew Registration Houston Area Community Services, Inc.1/11/2019 1:31 PM
DetailsProgram CodeInsertNew Registration CH1/11/2019 1:31 PM
DetailsEntity SubnameInsertNew Registration Avenue 360 South Central1/11/2019 1:31 PM
DatesParticipating Approval DateInsertNew Registration  1/11/2019 1:31 PM
DetailsStateInsertNew Registration Pending1/11/2019 1:31 PM
DatesRegistration DateInsertNew Registration 1/11/2019 1:31:37 PM1/11/2019 1:31 PM
DatesSigned By DateInsertNew Registration  1/11/2019 1:31 PM
DatesStart DateInsertNew Registration  1/11/2019 1:31 PM
TerminationsTermination CommentsInsertNew Registration  1/11/2019 1:31 PM
TerminationsTermination DateInsertNew Registration  1/11/2019 1:31 PM
TerminationsTermination Effective DateInsertNew Registration  1/11/2019 1:31 PM
TerminationsTermination ReasonInsertNew Registration  1/11/2019 1:31 PM