NCC205578_NOI 37964 Payment Verification_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/2/2020 3:34:03 PM (NCG01 NOI Submission)
Approve by Meloy, Michael 12/3/2020 8:26:54 AM (Review- Construction NOI 37964)
• Gamble, Aana C reassigned the task to Meloy, Michael 12/2/2020 3:36 PM
• The task was assigned to Gamble, Aana C by round robin distribution 12/2/2020 3:34 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 4, 2020 5:00
PM 12/2/2020 3:34 PM
Submit by Selkane, Aziza 1/28/2021 8:26:34 AM (Payment Verification for NCC205578)
* Michael F Milone
• Selkane, Aziza assigned the task to Selkane, Aziza 1/28/2021 8:24 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 14, 2021 5:00 PM
12/3/2020 8:27 AM

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•
V.
• yrnent Verification
NORTH CAROLINA
Envlro me tufQuuftty
Project Name
COD Dialysis Center
NC Reference No.*
NCG01-2020-5578
Certificate of
NCC205578
Coverage (COC)
No. *
Invoice Date
12/3/2020
Initial Invoice No.
NCC205578-2020
Initial Fee
$ 100.00
Invoice Due Date
1/2/2021
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNO1 at this step.
Payment Received* r Payment Received.
r Payment NOT RECEIVED.
Payment Status
PAID
Date Payme nt
1 /28/2021
Received *
(Or, if not received, date rejected for no paynent)
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
r Other
ePayment
555733690
Transaction
Number*
NOI Tracking No.
37964
Tracking ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-CHATI-k2021-COD Dialysis Center