Various Sample approved Memos from FSC (Financial Services Center)

 Change of address, activation, Change name and Way ahead activation

Change of Address - Stn 544GB

change of Name and Address - Stn 528GE

Newly Activated Clinic - Stn 521QB

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. We dont want to activate since Appt / enrollment App are

affected--in what way-how?

--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!

--End of Sample Approved Documents from FSC Office ---