Sample Activated Memo from FSC office

Sample of Activation 

Exceptional Sample of Activation (ahead of time!)

Note:  Sample of ahead of time approval.  This was Approved few 
months ahead of time-- Eff Date (1-11-22).   It can be registered but
not supposed to be in used by the site.  Therefore, put a note
of INACTIVE.

--INACTIVE FLAG          -  inactive
--OFFICIAL VA NAME       -  **not active til 1-11-23
--NPI can be registered  -  ask NPI team to assign one

NAME: HUNTINGTON VA CLINIC              STATE: INDIANA
  STATUS: National
  STREET ADDR. 1: 2859 NORTHPARK AVE STE 110
  CITY: HUNTINGTON                      ZIP: 46750-7959
  FACILITY TYPE: CBOC
ASSOCIATIONS: VISN                      PARENT OF ASSOCIATION: VISN 10
ASSOCIATIONS: PARENT FACILITY
  PARENT OF ASSOCIATION: MARION VA MEDICAL CENTER
  LOCATION TIMEZONE: EASTERN            COUNTRY: USA
  STATION NUMBER: 610GF
  OFFICIAL VA NAME: ** NOT ACTIVE TIL 1-11-23
  INACTIVE FACILITY FLAG: INACTIVE      AGENCY CODE: VA
  POINTER TO AGENCY: VA
  NPI: 1285302778
EFFECTIVE DATE/TIME: SEP 01, 2021       STATUS: ACTIVE
  NPI: 1285302778
TAXONOMY CODE: Ambulatory Health Care Facilities
  PRIMARY CODE: YES                     STATUS: ACTIVE

Exceptional Sample of Activation -- Change Name and relocation as well

  Post the sammple here!

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