Covered Entity Details

DSH340030AN DUKE UNIVERSITY HOSPITAL (Active) - information as of 4/24/2025 11:08:14 PM

Main Details

Name

DUKE UNIVERSITY HOSPITAL

Subdivision Name

Lenox Baker Children's Hospital - Genetics/Metabolism

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH340030AN

Medicare Provider Number

340030

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/11/2023

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Duke University Health System, Duke University Hospital
Thomas Andrew Owens, Executive Vice President and COO, DUHS, President DUH
(919) 681-6624

Primary Contact

Duke University Health System
Marcus Gumbrecht, 340B Clinical Pharmacist
(919) 684-1791

Addresses

Street Address

3000 Erwin Road
Durham, NC 27705

Billing Address

Duke Corporate Accounts Payable
Box 104131
Durham, NC 27708

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
NC		1417954942,1326045857,1992703540,1538166061
VA		1326045857,1417954942,1538166061,1992703540
SC		1326045857,1417954942,1538166061,1992703540

Shipping Addresses

Shipping Address 1

Morris Pharmacy
2301 Erwin Road
30 Duke Medicine Circle
Room 15110
Durham, NC 27710

Shipping Address 2

Duke University Hospital Pharmacy Storeroom
2301 Erwin Road
Pharmacy Storeroom
Room 0612
Durham, NC 27710

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
DSH340030AA	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health North Durham - Duke Nephrology North Durham	4220 N. Roxboro Street	Durham	NC	Active
DSH340030AB	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Family Medicine Center - Rheumatology	Marshall I. Pickens Building	Durham	NC	Active
DSH340030AC	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Outpatient Clinic - Smoking Cessation	4220 N. Roxboro Street	Durham	NC	Active
DSH340030AD	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Family Medicine Center - Smoking Cessation	Marshall I. Pickens Building	Durham	NC	Active
DSH340030AE	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Children's Evaluation Center - Autism Clinic	Exchange on Erwin	Durham	NC	Active
DSH340030AF	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Family Medicine Center - OB/GYN	Marshall I. Pickens Building	Durham	NC	Active
DSH340030AG	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Blood Cancer Center - Hematologic Oncology Treatment Center	2400 Pratt Street	Durham	NC	Active
DSH340030AH	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Blood Cancer Center - Hematologic Malignancies Clinic	2400 Pratt Street	Durham	NC	Active
DSH340030AJ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Blood Cancer Center - Adult Blood and Marrow Transplant Treatment Center	2400 Pratt Street	Durham	NC	Active
DSH340030AK	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Neurology	3000 Erwin Road	Durham	NC	Active
DSH340030AL	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Rheumatology	3000 Erwin Road	Durham	NC	Active
DSH340030AM	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Pain Medicine Clinic - Integrated Pain and Wellness	4309 Medical Park Drive	Durham	NC	Active
DSH340030AN	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Genetics/Metabolism	3000 Erwin Road	Durham	NC	Active
DSH340030AP	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Neurodevelopmental	3000 Erwin Road	Durham	NC	Active
DSH340030AQ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Child Development	3000 Erwin Road	Durham	NC	Active
DSH340030AR	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Orthopaedics	3000 Erwin Road	Durham	NC	Active
DSH340030AS	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Children's Hospital - Urology	3000 Erwin Road	Durham	NC	Active
DSH340030AT	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Children's Evaluation Center - Lakeview Psych.	Exchange on Erwin	Durham	NC	Active
DSH340030AU	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Cancer Center Hematology/Oncology Infusion Macon Pond - Women's Cancer Care Raleigh	4101 Macon Pond Road	Raleigh	NC	Active
DSH340030AV	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Cancer Center Hematology/Oncology Infusion Cary - Duke Cancer Center Cary	216 Ashville Ave	Cary	NC	Active
DSH340030AW	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Cancer Center Cary - Hematology Oncology Clinic	216 Ashville Ave	Cary	NC	Active
DSH340030AX	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Neuro Interventional Radiology	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030AY	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Diagnostic Radiology	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030AZ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Vascular Interventional Radiology	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030B	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Pain Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BA	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Benign Hematology Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BB	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Radiation Oncology	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BC	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Women's Cancer Care Raleigh- - Plastic Surgery Clinic	4101 Macon Pond Rd	Raleigh	NC	Active
DSH340030BD	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Women's Cancer Care Raleigh- - Surgical Oncology Clinic	4101 Macon Pond Rd	Raleigh	NC	Active
DSH340030BE	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Urology Oncology Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BF	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Endoscopy	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BG	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Wound Healing Center	3320 Wake Forest Rd	Raleigh	NC	Active
DSH340030BH	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Thoracic Oncology Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BJ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Cardiac Diagnostics	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BK	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Cancer Center Cary- - Surgical Oncology Clinic	216 Ashville Ave	Cary	NC	Active
DSH340030BL	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Emergency Department	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BM	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Oncology Infusion Services	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BN	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Hematology Oncology Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030BP	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - CT Scan	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BQ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Magnetic Resonance Imaging (MRI)	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BR	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Cardiac Catheterization	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BS	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Ultrasound	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BT	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - PET Imaging	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BU	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Outpatient Surgery Center	3300 Executive Dr	Raleigh	NC	Active
DSH340030BV	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Anesthesia	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BW	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Operating Room	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BX	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Nuclear Medicine	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BY	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Ambulatory Surgery	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030BZ	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Women's Cancer Care Raleigh- - Gynecology Oncology Clinic	4101 Macon Pond Rd	Raleigh	NC	Active
DSH340030CA	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Head and Neck Oncology	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030CB	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Women's Cancer Care Raleigh- - Hematology Oncology Clinic	4101 Macon Pond Rd	Raleigh	NC	Active
DSH340030CC	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh Hospital, a Campus of Duke University Hospital- - Respiratory Therapy	3400 Wake Forest Rd	Raleigh	NC	Active
DSH340030CD	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Surgical Oncology Clinic	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030CE	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Raleigh - Pulmonary Function Lab	3404 Wake Forest Rd	Raleigh	NC	Active
DSH340030H	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Outpatient Clinic	4220 N. Roxboro Street	Durham	NC	Active
DSH340030J	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Family Medicine Center	Marshall I. Pickens Building	Durham	NC	Active
DSH340030K	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Blood Cancer Center- Adult Blood and Marrow Transplant Clinic	2400 Pratt Street	Durham	NC	Active
DSH340030L	Child	DSH	DUKE UNIVERSITY HOSPITAL	Pavilion East at Lakeview	2608 Erwin Road	Durham	NC	Terminated
DSH340030M	Child	DSH	DUKE UNIVERSITY HOSPITAL	Lenox Baker Hospital Clinic	3000 Erwin Road	Durham	NC	Active
DSH340030N	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health Center at Morreene Road	932 Morreene Road	Durham	NC	Active
DSH340030P	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke University Medical Center Dialysis Unit	1306 Morreene Road	Durham	NC	Terminated
DSH340030Q	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Pain Medicine Clinic	4309 Medical Park Drive	Durham	NC	Active
DSH340030R	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Children's Evaluation Center	Exchange on Erwin	Durham	NC	Active
DSH340030S	Child	DSH	DUKE UNIVERSITY HOSPITAL	Radiology - Mobile MR - Radiology - Mobile MR	3000 Erwin Road	Durham	NC	Terminated
DSH340030T	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Ambulatory Surgery Center- Periop	2400 Pratt Street	Durham	NC	Active
DSH340030U	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Ambulatory Surgery Center- OR	2400 Pratt Street	Durham	NC	Active
DSH340030V	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Fetal Diagnostic Center	2608 Erwin Road	Durham	NC	Active
DSH340030W	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health North Durham - Duke Wound Management North Durham	4220 N. Roxboro Street	Durham	NC	Active
DSH340030X	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health North Durham - Duke Rheumatology North Durham	4220 N. Roxboro Street	Durham	NC	Active
DSH340030Y	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health North Durham - Duke Geriatrics North Durham	4220 N. Roxboro Street	Durham	NC	Active
DSH340030Z	Child	DSH	DUKE UNIVERSITY HOSPITAL	Duke Health North Durham - Duke Gastroenterology North Durham	4220 N. Roxboro Street	Durham	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Williford, Amanda 340B Program Coordinator Duke University Health System 9196608506	Gumbrecht, Marcus 340B Clinical Pharmacist Duke University Health System 9196841791	3/19/2025 1:05 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1053682146 (NC)		10/9/2024 4:13 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1982779286 (NC)		10/9/2024 4:13 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1366515819 (NC)		10/9/2024 4:13 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1366024085 (NC)		10/9/2024 4:13 AM
Details	Last Recertification Date	Update	Recertification		8/16/2024 4:48:10 PM	8/16/2024 4:48 PM
Contacts	Primary Contact	Update	Group Change Request	Petrovskis, Kriss Director, Pharmacy Business and Revenue Management Duke University Health System 9196813817	Williford, Amanda 340B Program Coordinator Duke University Health System 9196608506	8/5/2024 6:55 AM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Owens, Thomas Andrew Executive Vice President and COO, DUHS, President DUH Duke University Health System, Duke University Hospital 9196816624	10/11/2023 12:41 PM
Details	340B ID	Update	New Registration		DSH340030AN	10/11/2023 12:41 PM
Details	Entity Subname	Update	New Registration	Lenox Baker Children's Hospital	Lenox Baker Children's Hospital - Genetics/Metabolism	10/11/2023 12:41 PM
Dates	Participating Approval Date	Update	New Registration		10/11/2023 12:41:27 PM	10/11/2023 12:41 PM
Details	State	Update	New Registration	Pending	Approved	10/11/2023 12:41 PM
Dates	Signed By Date	Update	New Registration		10/11/2023 7:35:24 AM	10/11/2023 12:41 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/11/2023 12:41 PM
Addresses	Main Address	Insert	New Registration		3000 Erwin Road Durham, NC 27705	10/5/2023 1:13 PM
Addresses	Billing Address	Insert	New Registration		Duke Corporate Accounts Payable Box 104131 Durham, NC 27708	10/5/2023 1:13 PM
Addresses	Shipping Address	Insert	New Registration		Morris Pharmacy 2301 Erwin Road 30 Duke Medicine Circle Room 15110 Durham, NC 27710	10/5/2023 1:13 PM
Addresses	Shipping Address	Insert	New Registration		Duke University Hospital Pharmacy Storeroom 2301 Erwin Road Pharmacy Storeroom Room 0612 Durham, NC 27710	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417954942	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326045857	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1992703540	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538166061	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1053682146	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982779286	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1366515819	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1366024085	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326045857	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417954942	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538166061	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1992703540	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326045857	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417954942	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538166061	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/5/2023 1:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1992703540	10/5/2023 1:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/5/2023 1:13 PM
Contacts	Authorizing Official	Insert	New Registration		Owens, Thomas Andrew Executive Vice President and COO, DUHS, President DUH Duke University Health System, Duke University Hospital 9196816624	10/5/2023 1:13 PM
Contacts	Primary Contact	Insert	New Registration		Petrovskis, Kriss Director, Pharmacy Business and Revenue Management Duke University Health System 9196813817	10/5/2023 1:13 PM
Details	Assistance Received From Date	Insert	New Registration			10/5/2023 1:13 PM
Details	Assistance Received To Date	Insert	New Registration			10/5/2023 1:13 PM
Details	Last Recertification Date	Insert	New Registration			10/5/2023 1:13 PM
Details	Grant Number	Insert	New Registration			10/5/2023 1:13 PM
Details	340B ID	Insert	New Registration			10/5/2023 1:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/5/2023 1:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/5/2023 1:13 PM
Details	Medicare Provider Number	Insert	New Registration		340030	10/5/2023 1:13 PM
Details	Entity Name	Insert	New Registration		DUKE UNIVERSITY HOSPITAL	10/5/2023 1:13 PM
Details	NOFO Number	Insert	New Registration			10/5/2023 1:13 PM
Details	Program Code	Insert	New Registration		DSH	10/5/2023 1:13 PM
Details	Entity Subname	Insert	New Registration		Lenox Baker Children's Hospital	10/5/2023 1:13 PM
Dates	Participating Approval Date	Insert	New Registration			10/5/2023 1:13 PM
Details	State	Insert	New Registration		Pending	10/5/2023 1:13 PM
Dates	Registration Date	Insert	New Registration		10/5/2023 1:13:22 PM	10/5/2023 1:13 PM
Dates	Signed By Date	Insert	New Registration			10/5/2023 1:13 PM
Dates	Start Date	Insert	New Registration			10/5/2023 1:13 PM
Terminations	Termination Comments	Insert	New Registration			10/5/2023 1:13 PM
Terminations	Termination Date	Insert	New Registration			10/5/2023 1:13 PM
Terminations	Termination Effective Date	Insert	New Registration			10/5/2023 1:13 PM
Terminations	Termination Reason	Insert	New Registration			10/5/2023 1:13 PM